title: Association Between Difficult Airway Predictors and Failed Prehosptial Endotracheal Intubation.
abstract: OBJECTIVE
  Difficult airway predictors (DAPs) are associated with failure of endotracheal intubation (ETI) in the emergency department (ED). The purpose of this study was to determine if DAPs are associated with failure of prehospital ETI.
  
  
  METHODS
  This retrospective study compared the prevalence of DAPs in cases of failed prehospital ETI successfully intubated in the ED (FPH/SED) with cases with no prehospital attempt that were successfully intubated in the ED on the first attempt by a physician using direct laryngoscopy (NPH/SED). All cases were transported by ground or air to an academic, level-1 trauma center.
  
  
  RESULTS
  A total of 1377 ED ETIs were performed; 161 FPH/SED and 530 NPH/SED were identified. The odds ratios with 95% confidence intervals (CIs) of finding DAPs in the FPH/SED group compared with the NPH/SED group was blood = 5.80 (95% CI, 3.89-8.63), vomit = 2.01 (95% CI, 1.25-3.21), short neck = 2.67 (95% CI, 1.39-5.03), neck immobility = 2.52 (95% CI, 1.72-3.67), airway edema = 10.52 (95% CI, 4.15-29.92), facial trauma = 4.64 (95% CI, 2.91-7.39), and large tongue = 3.08 (95% CI, 1.75-5.40). When grouped by the number of DAPs per case (0, 1, 2, 3, or ≥ 4), the odds of multiple DAPs in cases of FPH/SED compared with NPH/SED ranged from 2.89 (95% CI, 1.71-4.90) with 1 DAP to 24.55 (95% CI, 10.60-56.90) with ≥ 4 DAPs.
  
  
  CONCLUSIONS
  Cases of FPH/SED have more DAPs than NPH/SEDs.
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Arizona Emergency Medicine Research Center, Tucson, AZ. Electronic address: jgaither@aemrc.arizona.edu.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Gaither
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Arizona Emergency Medicine Research Center, Tucson, AZ.
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Arizona Emergency Medicine Research Center, Tucson, AZ.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ennis
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Arizona Emergency Medicine Research Center, Tucson, AZ.
authors.forename: Jarrod
authors.initials: J
authors.lastname: Moiser
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Arizona Emergency Medicine Research Center, Tucson, AZ.
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005151:Facial Injuries / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007103:Immobilization / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology; D016017:Odds Ratio; D009929:Organ Size; D012189:Retrospective Studies; D012307:Risk Factors; D014059:Tongue / Q000033:anatomy & histology; D014193:Trauma Centers; D017211:Treatment Failure; D014839:Vomiting / Q000453:epidemiology; D055815:Young Adult