Rinderknecht Andrea S, Dyas Jenna R, Kerrey Benjamin T, Geis Gary L, Ho Mona H, Mittiga Matthew R
Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
University of Cincinnati College of Medicine, Cincinnati, OH.
Acad Emerg Med. 2017 Apr;24(4):411-421. doi: 10.1111/acem.13145. Epub 2017 Mar 24.
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).
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 detection), and timing data (duration of preoxygenation and laryngoscopy attempts).
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.
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.
我们试图描述和比较病历审查与视频审查，将其作为急诊科（ED）快速顺序插管（RSI）研究的数据收集来源。
这项回顾性队列研究比较了来自两个来源的关键RSI结果和过程数据的可用性及内容：12个月的儿科急诊RSI病历和视频数据。关键结果包括不良反应（氧合血红蛋白饱和度降低、生理变化、麻痹不足、呕吐）、过程组成部分（喉镜检查尝试次数、呼气末二氧化碳检测）以及时间数据（预充氧持续时间和喉镜检查尝试时间）。
我们审查了114例病例的566份带有视频数据的文件。视频审查发现的不良反应发生率（67%）高于病历审查（46%，p<0.0001），视频审查发现的饱和度降低发生率几乎是病历审查的两倍（34%对18%，p = 0.0002）。通过视频审查，关键RSI过程的执行情况和时间更可靠（预充氧的时间和持续时间，以及喉镜检查尝试的时间、持续时间和次数，均p<0.05）。视频审查发现221次喉镜检查尝试，而病历审查仅发现187次。
与视频审查相比，在儿科急诊科对RSI进行回顾性研究时，病历审查显著低估了不良反应，重要RSI过程要素的数据不一致，很少提供时间数据，且常常与视频审查的观察结果相冲突。RSI未来研究的解读和设计应考虑数据源的质量。
