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Association of advanced age with intubation-related adverse events in the emergency department: a multicentre prospective observational study
  1. Jin Takahashi1,
  2. Tadahiro Goto2,
  3. Hiraku Funakoshi1,
  4. Hiroshi Okamoto3,
  5. Yusuke Hagiwara4,
  6. Hiroko Watase5,
  7. Kohei Hasegawa6
  8. on behalf of the Japanese Emergency Medicine Network Investigators
    1. 1 Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
    2. 2 Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
    3. 3 Department of Critical Care Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
    4. 4 Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children’s Medical Center, Fuchu, Tokyo, Japan
    5. 5 Department of Surgery, University of Washington, Seattle, Washington, USA
    6. 6 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
    1. Correspondence to Dr Jin Takahashi, Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan; jint{at}


    Background While the older population accounts for an increasing proportion of emergency department (ED), little is known about intubation-related adverse events in this high-risk population. We sought to determine whether advanced age is associated with a higher risk of intubation-related adverse events in the ED.

    Methods This is an analysis of data from a prospective, 15-centre, observational study—the second Japanese Emergency Airway Network (JEAN-2) study. The current analysis included adult (aged ≥18 years) patients who underwent intubation in the ED between 2012 and 2018. The primary exposure was age (18–39, 40–64, 65–74, 75–84 and ≥85 years). The primary outcome was overall intubation-related adverse events during or immediately after an intubation. Adverse events were further categorised into major (hypotension, hypoxaemia, oesophageal intubation, cardiac arrest, dysrhythmia and death) and minor (endobronchial intubation, oesophageal intubation with early recognition, dental/lip trauma, airway trauma and regurgitation) adverse events. We constructed multivariable logistic regression models adjusting for seven potential confounders with generalised estimating equations that account for patients clustering within the ED.

    Results Among 9714 patients eligible for the analysis, 15% were aged ≥85 years, and 16% had adverse events. In the unadjusted models, advanced age was not significantly associated with the risk of overall adverse events. In the adjusted models, the association was significant (adjusted OR 1.41 in age ≥85 years (95% CI, 1.09 to 1.81) compared with age 18–39 years). Specifically, older patients had a significantly higher risk of major adverse events (adjusted OR in age ≥85 years 2.65 (95% CI, 1.78 to 3.94)), which was driven by the association of advanced age with an increased risk of hypotension (adjusted OR in ≥85 years, 5.69 (95% CI, 3.13 to 10.37)). By contrast, advanced age was not associated with minor adverse events.

    Conclusion Based on the data from a prospective multicentre study, advanced age was associated with higher risks of major adverse events.

    • airway
    • geriatrics
    • emergency departments

    Data availability statement

    No data are available. IRB does not allow data sharing.

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    Data availability statement

    No data are available. IRB does not allow data sharing.

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    • Handling editor Mary Dawood

    • Collaborators Japanese Emergency Medicine Network Investigators: Hiroshi Morita, MD; Takahisa Kawano, MD; Yohei Kamikawa, MD (Fukui University Hospital); Hideya Nagai, MD; Takashi Matsumoto, MD; Suguru Nonami, MD; Yusuke Miyoshi, MD (Fukui Prefectural Hospital); Sho Segawa, MD; Yuya Kitai, MD; Kenzo Tanaka, MD; Saburo Minami, MD (Kameda Medical Centre); Hiromasa Yakushiji, MD (Kishiwada Tokushukai Hospital); Hiroshi Okamoto, MD; Naoto Miyauchi, MD; Yudai Yano, MD (Kurashiki Central Hospital); Yukari Goto, MD (Nagoya Ekisaikai Hospital); Nobuhiro Sato, MD (Nigata City General Hospital); Koichiro Gibo, MD; Masashi Okubo, MD; Shojiro Oka, MD; Yukiko Nakayama, MD (Okinawa Chubu Prefectural Hospital); Nobuhiro Miyamae, MD (Otowa Hospital); Hirose Kaoru, MD; Taichi Imamura, MD; Azusa Uendan, MD (Shonan Kamakura General Hospital); Yasuaki Koyama, MD (St. Marianna University School of Medicine Hospital); Hiroshi Kamura, MD; Nakashima Yoshiyuki, MD; Jin Takahashi (Tokyo Bay Urayasu Ichikawa Medical Centre); Jin Irie, MD; Nobunaga Okada, MD (University Hospital, Kyoto Prefectural University of Medicine); Seiro Oya, MD (Yokohama Rosai Hospital); and Akihiko Inoue, MD (Hyogo Emergency Medical Centre).

    • Contributors JT took responsibility for the paper as a whole. JT, TG, HF and KH conceived the study. HO, YH, HW and KH supervised the conduct of the study. TG, HF and KH provided statistical advice. JT and TG analysed the data. JT drafted the manuscript, and all authors contributed substantially to its revision.

    • Funding The study was supported by grants from St. Luke’s Science Institute (H26, H27) (Tokyo, Japan). The grant number is not available.

    • Disclaimer The study sponsor has no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.

    • Competing interests None declared.

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

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