Post-intubation acute laryngeal injuries in infants and children: A new classification system.
OBJECTIVE
To compare the Classification of Acute Laryngeal Injuries (CALI) with other classifications to determine which of these offers the greatest sensitivity and specificity in predicting the development of subglottic stenosis.


METHODS
All children intubated for the first time in the pediatric intensive care unit were included and subjected to flexible fiber-optic laryngoscopy (FFL) within 8 h of extubation. Their injuries were categorized using the CALI, as well as adapted classifications from Lindholm, Colice and Benjamin. The children were followed up to determine who developed subglottic stenosis.


RESULTS
This study included 194 children, with a median age of 2.67 months. The sensitivity and specificity of the CALI were 90% and 73%, respectively. The CALI showed greater specificity than the adapted classifications from Colice and Benjamin (p < 0.001 for both), and greater sensitivity than the adapted classification from Lindholm (p < 0.001).


CONCLUSIONS
Based on the CALI, 90% of children who developed subglottic stenosis had moderate to severe injuries on the initial FFL. The CALI includes all injury types described by Benjamin, as well as a proposed severity scale for these lesions, and was predictive of the development of chronic laryngeal injury.
Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: causch@hotmail.com.
Cláudia
C
Schweiger
Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Denise
D
Manica
Otolaryngology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Ophtalmology and Otolaryngology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Gabriel
G
Kuhl
Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Leo
L
Sekine
Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Paulo José Cauduro
PJ
Marostica
D060666:Airway Extubation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000145:classification* / Q000175:diagnosis / Q000209:etiology*; D007830:Larynx / Q000293:injuries*; D008297:Male; D019838:Neck Injuries / Q000145:classification* / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity
Granulation tissue; Infants; Larynx; Subglottic stenosis; Ulceration