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New decision formulas for predicting endotracheal tube depth in children: analysis of neck CT images
  1. Se Uk Lee1,
  2. Jae Yun Jung2,
  3. Do Kyun Kim2,
  4. Young Ho Kwak2,
  5. Hyuksool Kwon3,
  6. Jun Hwi Cho4,
  7. Joong Wan Park2,
  8. Yoo Jin Choi3
  1. 1 Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. 2 Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
  3. 3 Department of Emergency Medicine, Seoul National University Bundang Hospital, Seong-nam, Korea
  4. 4 Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Korea
  1. Correspondence to Dr Jae Yun Jung, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Korea; matewoos{at}gmail.com

Abstract

Introduction The purpose of this study was to construct a prediction model for endotracheal tube depth using neck CT images.

Methods A retrospective image review was conducted that included patients who had undergone neck CT. Using sagittal neck CT images, we calculated the length between upper incisor and mid-trachea and then derived the model via regression analysis. The model was validated externally using chest radiographs of patients who had undergone endotracheal intubation. We compared performance of our model with that of other methods (Broselow tape and APLS formula) via Bland-Altman analysis and the percentage of estimations within 10% of the measured values.

Results A total of 1111 children were included in this study. The tube depth obtained from CT images was linearly related to body weight (tube depth (cm)=5.5+0.5×body wt (kg)) in children younger than 1 year and to height (tube depth (cm)=3+0.1×height (cm)) in children older than 1 year. External validation demonstrated that our new model showed better agreement with the desired tube depth than Broselow tape and APLS formula. The mean differences in children younger than 1 year were 0.61 cm and −1.24 cm for our formula and Broselow tape, respectively. The mean differences in children older than 1 year were −0.43 cm, −1.98 and −1.64 cm for our formula, Broselow tape and APLS formula, respectively. The percentages of estimates within 10% of the measured values were 52.7% and 35.8% for our formula and Broselow tape in children younger than 1 year, respectively, and 54.3%, 33.8% and 37.2% for our formula, Broselow tape and APLS formula in children older than 1 year, respectively (P<0.01).

Conclusion Our new formula is useful and more accurate than the currently available methods.

  • airway
  • Ct/mri
  • paediatric resuscitation

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Footnotes

  • Contributors JYJ conceived the initial research question, designed the study and contributed to data interpretation and production of the final manuscript. DKK, HK, YHK and JHC contributed to the development of the original research question and the study design and advised on data interpretation and production of the final manuscript. JWP and YJC contributed to data collection and interpretation and completed the ethics committee application. SUL performed the data collection and analysis and wrote the original draft.

  • Competing interests None declared.

  • Ethics approval Institutional review board of Bundang Hospital, Seoul National University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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