Success rate variation between trauma video review and chart review of trauma intubations at a Level 1 trauma center.

Abstract

First pass success (FPS) is an important quality metric for endotracheal intubations. FPS rates for trauma patients in the emergency department (ED) have been reported to be between 80% and 90% and are often based on self-reported data. We evaluated the number of intubation attempts seen on trauma video review (TVR) and compared them against charted attempts. We used TVR to review a consecutive cohort of adult trauma intubations in the ED at a level 1 trauma center over 10 months. Four reviewing physicians with specialization in emergency medicine participated in video and chart reviews and each case was reviewed by a minimum of two reviewers. We calculated FPS rates for the cohort and for each category of intubating physician. We evaluated interrater reliability using intraclass correlation coefficients (ICC). 50 patient cases were evaluated. The overall TVR FPS rate was 78% compared to a charted FPS rate of 92%. ICCs for chart reviews were 0.9 (CI 0.85-0.94) for a single rater and 0.97 (CI 0.96-0.98) for the average of multiple raters. ICCs for TVR were 0.55 (CI 0.4-0.68) between individual reviewers and 0.83 (CI 0.74-0.89) for the average across raters. TVR demonstrated lower FPS rates compared to self-reported data. TVR may offer a more accurate method of FPS estimation than retrospective chart reviews.