Evaluate The Incidence and Outcomes of Difficult Intubation in Emergency Department: A Cross Sectional Study | ||
| Zagazig University Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 05 November 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/zumj.2025.423240.4186 | ||
| Authors | ||
| Lamees Elhossiny Abdelwahab* 1; Emad Mohammed Salah2; Adel Hamed Elbaih3; Eslam AHMED Hassan Nasr4 | ||
| 1Emergency medicine, Zagazig University | ||
| 2Emergency Medicine department, faculty of medicine, zagazig university, zagazig, egypt | ||
| 3Emergency Medicine, faculty of Medicine Suez Canal University | ||
| 4anesthesia and surgical ICU , faculty of medecine , zagazig university , zagazig , sharkia | ||
| Abstract | ||
| Background: Tracheal intubation in emergency departments (ED) is more challenging than in operating rooms due to unstable patient physiology and uncontrolled settings. Difficult intubation occurs in 10–27% of ED cases and often requires multiple attempts. Early recognition and minimizing repeated attempts are critical. Our aim is to assess the incidence of difficult intubation in the ED and analyze associated patient outcomes. Methods: This interventional cross-sectional study included 390 adult emergency patients requiring emergency tracheal intubation at Zagazig University Hospital. All underwent clinical assessment, and laryngoscopy with a Macintosh blade. Difficult intubation was defined as Cormack–Lehane grade III or IV. Standardized protocols were applied for all participants. The primary outcome was the prevalence of difficult intubation, while secondary outcomes included the final results of cases with failed intubation. Results: The overall success rate was 81.3%. Failure was significantly associated with male sex ( p=0.0001), higher systolic BP (p=0.0002), lower diastolic BP (p=0.014), and lower respiratory rate (p=0.014). Laryngoscopic Grade I (11.4% vs. 0%, p=0.0005) and II (49.8% vs. 24.7%, p=0.0001) were more frequent in success. Hematemesis, vomiting, fractures, soft palate bleeding, hypersalivation, and macroglossia were higher in success; laryngeal edema and anatomical alterations were higher in failure. Success cases had shorter intubation time (33.4 vs. 38.0 sec, p<0.0001), and better hemodynamic stability (66.9% vs. 0%, p<0.0001). Among failed cases, 31.5% required ICU admission, 17.8% tracheostomy, and 13.7% died. Conclusion: ED intubation failure was 18.7%, associated with male sex, Grade IV view, anatomical alterations, and critical conditions. | ||
| Keywords | ||
| Difficult intubation; Emergency department; Airway management; Intubation outcomes; Hemodynamic stability | ||
|
Statistics Article View: 10 |
||
