Post-intubation acute laryngeal injuries in infants and children: A new classification system.
OBJECTIVE
To compare the Classification of Acute Laryngeal Injuries (CALI) with other classifications to determine which of these offers the greatest sensitivity and specificity in predicting the development of subglottic stenosis.


METHODS
All children intubated for the first time in the pediatric intensive care unit were included and subjected to flexible fiber-optic laryngoscopy (FFL) within 8 h of extubation. Their injuries were categorized using the CALI, as well as adapted classifications from Lindholm, Colice and Benjamin. The children were followed up to determine who developed subglottic stenosis.


RESULTS
This study included 194 children, with a median age of 2.67 months. The sensitivity and specificity of the CALI were 90% and 73%, respectively. The CALI showed greater specificity than the adapted classifications from Colice and Benjamin (p < 0.001 for both), and greater sensitivity than the adapted classification from Lindholm (p < 0.001).


CONCLUSIONS
Based on the CALI, 90% of children who developed subglottic stenosis had moderate to severe injuries on the initial FFL. The CALI includes all injury types described by Benjamin, as well as a proposed severity scale for these lesions, and was predictive of the development of chronic laryngeal injury.
['Schweiger|Cláudia|C|', 'Manica|Denise|D|', 'Kuhl|Gabriel|G|', 'Sekine|Leo|L|', 'Marostica|Paulo José Cauduro|PJ|']
D060666:Airway Extubation D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D015278:Intensive Care Units, Pediatric D007442:Intubation, Intratracheal D007828:Laryngoscopy D007829:Laryngostenosis D007830:Larynx D008297:Male D019838:Neck Injuries D011446:Prospective Studies D012680:Sensitivity and Specificity
Infants Subglottic stenosis Granulation tissue Larynx Ulceration