Bordini Martina, Orsini Luca, Li Simon Y W, Olsen Julia, Stein Mary Lyn, Sarmiento Argüello Lina A, Hesselink Emily B, Lee Angela C, Echeverry Piedad C, Lee Lisa K, O'Brien Elizabeth M, Dalal Priti G, Hunyady Agnes, Whyte Simon, Brooks-Peterson Melissa, Garcia-Marcinkiewicz Annery G, Kovatsis Pete, Peyton James, Von Ungern-Sternberg Britta S, Fiadjoe John, Matava Clyde
Department of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; DIMEC, University of Bologna, Bologna, Italy.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; DIMEC, University of Bologna, Bologna, Italy.
Br J Anaesth. 2025 Nov;135(5):1499-1510. doi: 10.1016/j.bja.2025.04.033. Epub 2025 May 29.
Cognitive errors are known contributors to poor decision-making in healthcare. However, their incidence and extent of their contribution to negative outcomes during difficult airway management are unknown. We aimed to identify cognitive errors during paediatric difficult airway management using data from the Pediatric Difficult Intubation (PeDI) registry, to determine patient and clinician factors associated with these errors, and their contribution to complications.
We conducted a retrospective analysis of the PeDI registry data including cases with at least three intubation attempts. Cognitive error definitions were adapted to airway management, and predefined clinical endpoints were used to identify cognitive errors. A subanalysis was performed for children weighing <5 kg. Our primary outcome was the overall incidence of cognitive errors. Secondary outcomes included the incidence of specific cognitive error subtypes, associations with patient and clinician factors, and the relationship between cognitive errors and complications.
Cognitive errors were identified in 17.4% (487/2801) of cases, with fixation errors being the most common (11.5%), followed by omission bias (5.9%) and overconfidence bias (4.5%). Non-anaesthesiologist clinicians had the highest odds of cognitive errors. The presence of at least one cognitive error was independently associated with a higher risk of complications (adjusted odds ratio, 1.86 [95% confidence interval, 1.53-2.27]; P<0.001), and multiple errors increased the likelihood of severe complications (adjusted odds ratio, 2.48 [95% confidence interval, 1.24-4.94]; P=0.01).
Cognitive errors occurred in nearly 20% of paediatric difficult airway encounters and were linked to increased complications. Further research should refine error definitions and develop mitigation strategies to improve outcomes.
认知错误是导致医疗保健决策不佳的已知因素。然而，在困难气道管理过程中，其发生率以及对不良后果的影响程度尚不清楚。我们旨在利用儿科困难插管（PeDI）登记处的数据，识别儿科困难气道管理过程中的认知错误，确定与这些错误相关的患者和临床医生因素，以及它们对并发症的影响。
我们对PeDI登记处的数据进行了回顾性分析，包括至少进行了三次插管尝试的病例。将认知错误的定义应用于气道管理，并使用预先定义的临床终点来识别认知错误。对体重<5kg的儿童进行了亚分析。我们的主要结局是认知错误的总体发生率。次要结局包括特定认知错误亚型的发生率、与患者和临床医生因素的关联，以及认知错误与并发症之间的关系。
在17.4%（487/2801）的病例中发现了认知错误，其中固定错误最为常见（11.5%），其次是遗漏偏差（5.9%）和过度自信偏差（4.5%）。非麻醉科临床医生出现认知错误的几率最高。至少存在一个认知错误与更高的并发症风险独立相关（调整后的优势比，1.86[95%置信区间，1.53 - 2.27]；P<0.001），多个错误增加了严重并发症的可能性（调整后的优势比，2.48[95%置信区间，1.24 - 4.94]；P = 0.01）。
在近20%的儿科困难气道病例中发生了认知错误，并且与并发症增加有关。进一步的研究应完善错误定义并制定缓解策略以改善结局。
