Evidence map›Paper›PMID 39982154›Full record

ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2025

Tracheal Intubation by Attending Physicians in a U.S. Registry, 2016-2020: Analysis by PICU Participation in a Skills Maintenance Program and Fellowship Training.

Mizue Kishida, Robert A Berg, Natalie Napolitano, John Berkenbosch, Andrea Talukdar, Philipp Jung, Matthew P Malone, Simon J Parsons, Ilana Harwayne-Gidansky, Sholeen Nett and 27 more

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Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

37 authors.

Mizue KishidaDivision of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
Robert A BergDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Natalie NapolitanoRespiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
John BerkenboschDivision of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Louisville, KY.
Andrea TalukdarDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Nebraska and University of Nebraska Medical Center, Omaha, NE.
Philipp JungPaediatric Department, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Matthew P MaloneDivision of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR.
Simon J ParsonsSection of Critical Care, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada.
Ilana Harwayne-GidanskyDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Bernard and Millie Duker Children's Hospital at Albany Med, Albany, NY.
Sholeen NettSection of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Lily GlaterDivision of Pediatric Critical Care Medicine, Steven & Alexandra Cohen Children's Medical Center of New York, Zucker School of Medicine/Northwell, New Hyde Park, NY.
Conrad KrawiecDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA.
Asha ShenoiDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY.
Awni Al-SubuDepartment of Pediatrics, University of Wisconsin-Madison, Madison, WI.
Lee PolikoffDivision of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI.
Serena P KellyDivision of Critical Care Medicine, Department of Pediatrics, OHSU Doernbecher Children's Hospital, Portland, OR.
Carolyn K AdamsPediatric Intensive Care Unit, UW Health-American Family Children's Hospital, Madison, WI.
John S GiulianoDepartment of Pediatrics, Critical Care Medicine, Yale University School of Medicine, New Haven, CT.
Shashikanth AmbatiDivision of Pediatric Critical Care, Department of Pediatrics, Bernard and Millie Duker Children's Hospital at Albany Med, Albany, NY.
David TellezDepartment of Critical Care, Phoenix Childrens Hospital, Phoenix, AZ.
Rebecca J MartinDivision of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR.
Anthony LeeDivision of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
Ryan K BreuerDepartment of Pediatrics, Division of Critical Care Medicine, John R. Oishei Children's Hospital, Buffalo, NY.
Katherine V BiagasDepartment of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
Palen P MalloryDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital & Health Center, Duke University, Durham, NC.
Kelly L CorbettSection of Pediatric Critical Care Medicine, Department of Pediatrics, Dartmouth Health Children's, Geisel School of Medicine at Dartmouth, Lebanon, NH.
G Kris BysaniMedical City Children's Hospital, Pediatric Acute Care Associates of North Texas, Dallas, TX.
Laurence Ducharme-CrevierDivision of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
Samantha WirkowskiDivision of Pediatric Critical Care, University of Louisville, Norton Children's Hospital, Louisville, KY.
Matthew PintoDepartment of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY.
Megan ToalDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY.
Rachel K MarlowPediatric Critical Care, Phoenix Children's Hospital, Phoenix, AZ.
Michelle Adu-DarkoDepartment of Pediatrics, University of Virginia Medical Center, Charlottesville, VA.
Justine ShultsDivision of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Vinay NadkarniDepartment of Anesthesiology, Critical Care Medicine, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Akira NishisakiDepartment of Anesthesiology, Critical Care Medicine, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
AHRQ HHS R18 HS024511NCATS NIH HHS UL1 TR001863
6 · The paper itself

Abstract

objectivesTracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship.

designRetrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending's first attempt success and the secondary outcome was adverse airway outcome in the first attempt.

settingThirty-three PICUs in North America. PATIENTS: Children receiving TI.

interventionsNone. MEASUREMENTS AND MAIN

resultsOverall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6-14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47-0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending's first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55-1.01]; p = 0.058).

conclusionsAttendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.

Indexed as

Clinical CompetenceFellowships and ScholarshipsIntensive Care Units, PediatricIntubation, IntratrachealMedical Staff, HospitalChildChild, PreschoolFemaleHumansInfantMaleRegistriesRetrospective StudiesUnited States

Identifiers

PMID39982154
PMCPMC11850027

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.