Paediatric difficult intubations and the impact of timing of weekend versus weekday cases: an analysis of the Pediatric Difficult Intubation registry

Authors

Christy J. Crockett, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Christy.crockett@vumc.org.
Judit Szolnoki, Department of Anesthesiology, Nemours Children's Hospital, Orlando, FL, USA.
Sabina Khan, McGovern Medical School, UT Health Houston, TX, USA.
Angela C. Lee, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Alexander Kaizer, Department of Biostatistics & Informatics and the Center for Innovative Design & Analysis, Colorado School of Public Health, Aurora, CO, USA.
Patrick Olomu, Department of Anesthesia, University of Iowa, Iowa City, IA, USA.
Melissa Brooks Peterson

Document Type

Journal Article

Publication Date

8-18-2025

Journal

British journal of anaesthesia

DOI

10.1016/j.bja.2025.07.033

Keywords

airway management; difficult intubation; paediatric airway complications; paediatric intubation; tracheal intubation

Abstract

BACKGROUND: Off-hours presentation has been shown to be independently associated with tracheal intubation-related adverse events in patients with predicted difficult airway. The comparison of the complication rates of paediatric difficult intubations on weekends vs weekdays is unknown. The primary objective of this retrospective review is to determine the complication rates for paediatric difficult intubation cases that occur on a weekend vs a weekday. METHODS: We performed a retrospective review of data from the Pediatric Difficult Intubation registry, with service dates June 8, 2012 to May 9, 2023, to compare complication rates (total complications, hypoxaemia, non-hypoxaemia complications, and first-attempt success rate) during paediatric difficult intubations that occurred on the weekends vs weekdays. Research electronic data capture was used to standardise data collection across institutions. RESULTS: We reviewed a total of 8031 cases of difficult paediatric intubations. Two hundred and eighty-five (3.5%) were performed on the weekend, and 7746 (96.5%) were performed on a weekday. Complication rates with paediatric difficult intubations (total complications, hypoxaemia, and non-hypoxaemia complications) were significantly higher on weekends compared with weekdays. The odds of any complication were more than two times higher on the weekends compared with weekdays (odds ratio 2.13, 95% confidence interval 1.49-3.07, P<0.0001). CONCLUSIONS: This study supports paediatric anaesthetists' clinical decision-making to postpone nonurgent paediatric procedures in children with a history of a difficult airway from weekend to weekday to decrease risk of airway management complications and improve patient safety and quality of care.

APA Citation

Crockett, Christy J.; Szolnoki, Judit; Khan, Sabina; Lee, Angela C.; Kaizer, Alexander; Olomu, Patrick; and Peterson, Melissa Brooks, "Paediatric difficult intubations and the impact of timing of weekend versus weekday cases: an analysis of the Pediatric Difficult Intubation registry" (2025). GW Authored Works. Paper 7747.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7747

Department

Anesthesiology and Critical Care Medicine