(1054) Predictors of High-Yield Airway Evaluations in Pediatric Patients

Introduction: Vanderbilt University Medical Center conducts invasive airway evaluations involving laryngoscopy for pediatric patients. If a tracheostomy is later deemed necessary, patients must undergo another invasive procedure in the operating room with additional anesthesia. This study aims to identify predictors associated with higher-yield airway evaluations, defined as instances where the evaluation prompts changes in management.

Methods: A retrospective chart review was conducted on 72 pediatric patients with no prior laryngoscopies, who underwent airway evaluations following an inpatient pediatric ENT consult between June 2020 and June 2022. Data on patient characteristics, comorbidities, and airway evaluation findings were collected.

Results: Airway evaluation findings prompted changes in management 32% of the time. Tracheal edema was the only finding significantly affecting the recommendation for a repeat procedure (p = 0.041). Specifically, glottic edema seen during airway evaluation significantly correlated with a repeat scope recommendation (p = 0.004). On average, it took approximately 27 days from airway evaluation to a change in airway status (around 57 days for tracheostomy and around 12 days for extubation). O2 requirement (p = 0.046) and having a syndrome (p = 0.007) were the only statistically significant factors among the reasons for airway evaluation. There was no statistically significant difference in rates of incision/dilation, steroid injections, or airway cocktails.

Conclusions: Patients with higher-yield airway evaluations exhibited elevated rates of syndromes and O2 requirement before evaluation. Tracheal and glottic edema seem to occur at higher rates in those patients who need a repeat airway procedure. Determining which patients may have higher yield airway evaluations may help decrease double anesthesia. The primary limitation of this study was the small population size.