{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:45:48Z","timestamp":1786470348455,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Airway management in the Emergency Department (ED) can be challenging, particularly in children. Difficult laryngoscopy reduces first\u2010pass success and increases complications, but pediatric ED data remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective, observational study of pediatric intubations recorded in the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) between 2012 and 2025, including 25 Pediatric Research in Emergency Departments International Collaborative (PREDICT) sites. The primary outcome was the incidence of difficult laryngoscopy. Secondary outcomes were the impact of difficult laryngoscopy on First\u2010Pass Success (FPS) and adverse events. The main exposure variable was laryngoscopic grade, defined as difficult when a Cormack\u2013Lehane Grade 3 or 4 view was encountered on the first attempt. Patient, procedural, and operator characteristics were assessed as potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 946 pediatric ED intubations recorded across 55 sites (including 25 PREDICT pediatric sites) between 2012 and 2025, 865 were included in the analysis after exclusion of cases with missing laryngoscopic grade. The median age was 3.5\u2009years. Difficult laryngoscopy (Cormack\u2013Lehane grade 3\u20134) was observed in 65 cases (7.5%). FPS was significantly lower in patients with a difficult view compared with those with a non\u2010difficult view (41.5% vs. 87.9%; OR 0.10, 95% CI 0.06\u20130.17). Adverse events were more frequent in the difficult\u2010view group, including hypoxaemia (38.5% vs. 11.5%; OR 4.81, 95% CI 2.79\u20138.29) and esophageal intubation (15.4% vs. 1.3%; OR 14.36, 95% CI 5.73\u201335.98).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Difficult laryngoscopy in pediatric ED intubations is relatively infrequent but associated with reduced FPS and increased complications. These findings emphasize the importance of ongoing quality improvement and may help inform training and escalation strategies. Continued registry participation is valuable to capture these low\u2010frequency events and better understand their consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70242","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T13:06:56Z","timestamp":1781615216000},"page":"1117-1125","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Difficult Laryngoscopy on First\u2010Pass Success and Adverse Events in Pediatric Emergency Department Intubations"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-0324","authenticated-orcid":false,"given":"Tom","family":"Solan","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine The Royal Children's Hospital  Victoria Australia"},{"name":"Clinical Sciences Murdoch Children's Research Institute  Victoria Australia"},{"name":"Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences University of Melbourne  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Sabato","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Faculty of Medicine, Dentistry, and Health Sciences University of Melbourne  Victoria Australia"},{"name":"Department of Anaesthesia and Pain Management The Royal Children's Hospital  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5569-704X","authenticated-orcid":false,"given":"Hatem","family":"Alkhouri","sequence":"additional","affiliation":[{"name":"Intelligence and Support for Innovation, Transformation and Evaluation, Agency for Clinical Innovation  Sydney New South Wales Australia"},{"name":"Faculty of Medicine The University of Sydney  New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dinh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Royal Prince Alfred Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5268-6153","authenticated-orcid":false,"given":"Katie","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Queensland Children's Hospital  Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Tagg","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences University of Melbourne  Victoria Australia"},{"name":"Department of Emergency Medicine Sunshine Hospital  Victoria 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