Evaluating the Accuracy of Laryngoscopic View Documentation During Tracheal Intubation in a Pediatric Emergency Department.

OBJECTIVES

Review of self-reported data in the electronic medical record (EMR) is the standard approach to the study of emergency airway management. Despite this, very little research has been done into the accuracy of the laryngoscopic views documented in the EMR during intubation in the emergency department. Complicating matters further, the original Cormack-Lehane (CL) airway grading system and the newer modified CL grading system have overlapping definitions. The objective of this study was to compare the laryngoscopic views documented in the EMR to the laryngoscopic views seen on intraoral video during intubation in a pediatric emergency department.

METHODS

This was a retrospective review of prospectively collected observational data of patients undergoing intubation in an academic pediatric emergency department from February 2022 to February 2025. The main outcome was modified CL grade documented in the EMR vs modified CL grade seen on intraoral video. Correctly graded airways were defined as the modified CL grade documented in the EMR matching the best modified CL grade seen on intraoral video.

RESULTS

Airways were often incorrectly graded, occurring in 68 out of 161 attempts (42.2%). The most common CL grade discrepancy was documentation of a grade 1 view in the EMR when the best view on video was grade 2a or 2b (n = 63).

CONCLUSION

Future airway research must account for potential inaccuracies in self-reported laryngoscopic views and/or inconsistencies between the use of the original versus modified CL airway grading system. More research is needed into which aspects of airway management are inaccurately recorded in the EMR.