Teaching a tracheotomy handoff tool to pediatric first responders

Introduction: The Critical Airway Risk Evaluation (CARE) system is an airway classification system we designed to improve handoffs between caregivers by describing the risk of a patient's airway above the tracheotomy tube, and therefore the correct resuscitation maneuvers in the event of an airway emergency. It is designed to quickly communicate 3 categories: 1-easily intubatable; 2-intubatable with specialized techniques or equipment; or 3 not intubatable. We have demonstrated previously that the system is easily taught to and used by pediatric otolaryngologists. For this system to be useful, it must be usable by a broader group, including first responders to a tracheostomy related airway emergency. The objective of this study is to analyze the reliability of teaching and ease of learning the CARE system among practicing otolaryngologists, otolaryngology residents, and pediatric residents. Methods: A brief tutorial was designed to introduce the scale and was presented to practicing otolaryngologists, otolaryngology residents, and pediatrics residents. A 30-point questionnaire was administered in which patient's airways and airway management techniques were described. Participants were asked to classify each example according to the CARE system. Statistical analysis was performed using Student's r-test and Fleiss' kappa reliability. Results: A total of 66 physicians participated in the study. The pediatric residents correctly identified the patients' airway class 89% of the time (26.6/30 +/- SD = 2.9). Otolaryngology attendings and residents answered correctly 92% of the time (27.7/30 +/- SD = 2.9), which was not statistically different (p = 0.23). Inter-rater reliability was also substantial among all groups, with a Fleiss' kappa greater than 0.7 for all groups. Conclusions: This study demonstrates that the system can be taught to pediatrics residents as effectively as it can be taught to otolaryngology residents and practicing otolaryngologists and, therefore, can be effectively utilized in inter-disciplinary handoffs to facilitate information transfer to potential first responders.