Evidence map›Paper›PMID 40447486›Full record

ArticleBritish journal of anaesthesia2025

Incidence of cognitive errors in difficult airway management: an inference human factors study from the Pediatric Difficult Intubation Registry.

Martina Bordini, Luca Orsini, Simon Y W Li, Julia Olsen, Mary Lyn Stein, Lina A Sarmiento Argüello, Emily B Hesselink, Angela C Lee, Piedad C Echeverry, Lisa K Lee and 12 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
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

5 citing papers in PubMed.

  1. Review
  2. Review
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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

22 authors.

Martina BordiniDepartment 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.
Luca OrsiniDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; DIMEC, University of Bologna, Bologna, Italy.
Simon Y W LiSchool of Psychological Science, The University of Western Australia, Perth, WA, Australia; Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, WA, Australia.
Julia OlsenDepartment of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Mary Lyn SteinDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
Lina A Sarmiento ArgüelloDepartment of Pediatric Anesthesiology, Instituto Nacional de Pediatría, Mexico City, Mexico; Department of Pediatric Anesthesiology, Centro Pediátrico del Corazón ABC-Kardias, Mexico City, Mexico.
Emily B HesselinkAnesthesiology, University of Wisconsin-Madison, Madison, WI, USA.
Angela C LeeDivision of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, DC, USA; Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Piedad C EcheverryAnesthesia, Instituto Roosevelt, Bogota, Colombia.
Lisa K LeeDepartment of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA, USA.
Elizabeth M O'BrienDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Priti G DalalAnesthesiology and Peri-operative Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.
Agnes HunyadyDepartment of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Simon WhyteDepartment of Anesthesia, British Columbia's Children's Hospital, Vancouver, BC, Canada; Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Melissa Brooks-PetersonDivision of Pediatric Anesthesiology Administrative Offices, Children's Hospital Colorado, Denver, CO, USA.
Annery G Garcia-MarcinkiewiczDepartment of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA.
Pete KovatsisDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
James PeytonDepartment of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
Britta S Von Ungern-SternbergDepartment of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, WA, Australia; Perioperative Care Program, Perioperative Medicine Team, The Kids Research Institute Australia, Nedlands, WA, Australia.
John FiadjoeDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Clyde MatavaDepartment of Anesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: clyde.matava@sickkids.ca.
PeDI Collaborative Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCognitive 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.

methodsWe 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.

resultsCognitive 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).

conclusionsCognitive 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.

Indexed as

Airway ManagementCognitionIntubation, IntratrachealMedical ErrorsChildChild, PreschoolClinical CompetenceFemaleHumansIncidenceInfantInfant, NewbornMaleRegistriesRetrospective Studiesairway managementbiascognitive errordifficult airwayhuman factorshuman performancemedical errorpaediatric difficult airway

Identifiers

PMID40447486
PMCPMC12597392

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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.