Dean Preston, Hooker Maria, Kerrey Benjamin T, Frey Mary, Zhang Yin, Boyd Stephanie, Ahaus Karen, Edmunds Katherine
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Am Coll Emerg Physicians Open. 2025 Jul 24;6(5):100227. doi: 10.1016/j.acepjo.2025.100227. eCollection 2025 Oct.
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.
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.
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).
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.
回顾电子病历（EMR）中自我报告的数据是研究急诊气道管理的标准方法。尽管如此，对于急诊科插管期间EMR中记录的喉镜视野准确性的研究却很少。更复杂的是，最初的科马克-莱汉内（CL）气道分级系统和更新的改良CL分级系统存在重叠的定义。本研究的目的是比较儿科急诊科插管期间EMR中记录的喉镜视野与口内视频中看到的喉镜视野。
这是一项对2022年2月至2025年2月在一家学术性儿科急诊科接受插管患者的前瞻性收集的观察数据进行的回顾性研究。主要结果是EMR中记录的改良CL分级与口内视频中看到的改良CL分级。气道分级正确定义为EMR中记录的改良CL分级与口内视频中看到的最佳改良CL分级相匹配。
气道分级经常错误，在161次尝试中有68次（42.2%）出现这种情况。最常见的CL分级差异是当视频中的最佳视野为2a或2b级时，EMR中记录为1级视野（n = 63）。
未来的气道研究必须考虑自我报告的喉镜视野中的潜在不准确之处和/或原始CL气道分级系统与改良CL气道分级系统使用之间的不一致性。需要更多的研究来了解EMR中气道管理的哪些方面记录不准确。
