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

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: TVR demonstrated lower FPS rates compared to self-reported data. TVR may offer a more accurate method of FPS estimation than retrospective chart reviews.