title: Increased Occurrence of Tracheal Intubation-Associated Events During Nights and Weekends in the PICU.
abstract: OBJECTIVE
  Adverse tracheal intubation-associated events are common in PICUs. Prior studies suggest provider and practice factors are important contributors to tracheal intubation-associated events. Little is known about how the incidence of tracheal intubation-associated events is affected by the time of day, day of the week, or presence of in-hospital attending-level intensivists. We hypothesize that tracheal intubations occurring during nights and weekends are associated with a higher frequency of tracheal intubation-associated events.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Twenty international PICUs.
  
  
  METHODS
  Critically ill children requiring tracheal intubation.
  
  
  METHODS
  None.
  
  
  RESULTS
  We analyzed 5,096 tracheal intubation courses from July 2010 to March 2014 from the prospective multicenter National Emergency Airway Registry for Children. Frequency of a priori-defined tracheal intubation-associated events was the primary outcome. Occurrence of any tracheal intubation-associated events and severe tracheal intubation-associated events were more common during nights (19:00 to 06:59) and weekends compared with weekdays (19% vs 16%, p = 0.01; 7% vs 6%, p = 0.05, respectively). This difference was significant in emergent intubations after adjusting for site-level clustering and patient factors: for any tracheal intubation-associated events: adjusted odds ratio, 1.20; 95% CI, 1.02-1.41; p = 0.03; but not significant in nonemergent intubations: adjusted odds ratio, 0.94; 95% CI, 0.63-1.40; p = 0.75. For emergent intubations, PICUs with home-call attending coverage had a significantly higher frequency of tracheal intubation-associated events during nights and weekends (adjusted odds ratio, 1.29; 95% CI, 1.01-1.66; p = 0.04), and this difference was attenuated in PICUs with in-hospital attending coverage (adjusted odds ratio, 1.12; 95% CI, 0.91-1.39; p = 0.28).
  
  
  CONCLUSIONS
  Higher occurrence of tracheal intubation-associated events was observed during nights and weekends. This difference was primarily attributed to emergent intubations. In- hospital attending physician coverage attenuated this discrepancy between weekdays versus nights and weekends but was not fully protective for tracheal intubation-associated events.
authors.affiliation: 1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, NC. 2Department of Pediatrics, Division of Critical Care Medicine, Yale University School of Medicine, New Haven, CT. 3Department of Nursing, Respiratory Care, and Neurodiagnostics, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Division of Pediatric Intensive Care, Starship Children's Health Center, Grafton, Auckland, New Zealand. 5Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.forename: Natalie
authors.initials: N
authors.lastname: Napolitano
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Nuthall
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012189:Retrospective Studies; D013995:Time