Paediatric intubation in Scottish emergency departments

Background: Intubation of children in the emergency department setting is uncommon. This prospective observational study examines the practice of paediatric intubation in Scottish adult/paediatric urban emergency departments. Methods: A prospective observational study of every intubation attempt was performed in seven urban Scottish emergency departments in 1999 and 2000. Children were defined as those patients who were less than 13 years of age on the day of presentation. Prehospital intubations were only included if they were performed by a mobile medical team doctor from one of the seven hospitals. Results: A total of 1713 patients were identified, 44 of whom (2.6%) were children. The median age was 4 years ( range 0 - 12 years), and 57% ( 25 of 44) of intubations were performed on patients with traumatic injuries. Emergency physicians attempted intubation in 27% ( 12 of 44) of cases, anaesthetists in 73% ( 32 of 44); 18% ( eight of 44) of patients were intubated in nontraumatic cardiac arrest, 68% ( 30 of 44) underwent rapid sequence intubation (RSI), one (2%) had inhalational anaesthesia and 13 (30%) were intubated without drugs. Eighty per cent ( 35 of 44) of patients were intubated at the first attempt; eight patients required two attempts, and one required three attempts. Three children were intubated prehospital by mobile medical teams. Emergency physicians intubated more patients with 'physiological compromise' (100% vs 91%). Conclusions: Paediatric intubation in the emergency department is uncommon. Collaboration and appropriate training for doctors in emergency medicine, anaesthesia and paediatrics is essential.