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Studying the Safety and Performance of Rapid Sequence Intubation: Data Collection Method Matters
Author(s) -
Rinderknecht Andrea S.,
Dyas Jenna R.,
Kerrey Benjamin T.,
Geis Gary L.,
Ho Mona H.,
Mittiga Matthew R.
Publication year - 2017
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13145
Subject(s) - medicine , laryngoscopy , intubation , emergency department , emergency medicine , chart , medical emergency , duration (music) , anesthesia , intensive care medicine , art , statistics , mathematics , literature , psychiatry
Objective We sought to describe and compare chart and video review as data collection sources for the study of emergency department ( ED ) rapid sequence intubation ( RSI ). Methods This retrospective cohort study compares the availability and content of key RSI outcome and process data from two sources: chart and video data from 12 months of pediatric ED RSI . Key outcomes included adverse effects (oxyhemoglobin desaturation, physiologic changes, inadequate paralysis, vomiting), process components (number of laryngoscopy attempts, end‐tidal CO 2 detection), and timing data (duration of preoxygenation and laryngoscopy attempts). Results We reviewed 566 documents from 114 cases with video data. Video review detected higher rates of adverse effects (67%) than did chart review (46%, p < 0.0001), identifying almost twice the rate of desaturation noted in the chart (34% vs. 18%, p = 0.0002). The performance and timing of key RSI processes were significantly more reliably available via video review (timing and duration of preoxygenation, as well as timing, duration, and number of laryngoscopy attempts, all p < 0.05). Video review identified 221 laryngoscopy attempts, whereas chart review only identified 187. Conclusions When compared with video review for retrospective study of RSI in a pediatric ED , chart review significantly underestimated adverse effects, inconsistently contained data on important RSI process elements, rarely provided time data, and often conflicted with observations made on video review. Interpretation of and design of future studies of RSI should take into consideration the quality of the data source.