Article Text

Download PDFPDF
Appraisal of a scoring instrument for training and testing neonatal intubation skills
  1. Romy N Bouwmeester1,
  2. Mathijs Binkhorst1,
  3. Nicole K Yamada2,
  4. Rosa Geurtzen3,
  5. Arno F J van Heijst1,
  6. Louis P Halamek2,
  7. Jos M T Draaisma3,
  8. Marije Hogeveen1
  1. 1 Department of Neonatology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2 Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford University, Palo Alto, California, USA
  3. 3 Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Mathijs Binkhorst, Department of Neonatology, Amalia Children’s Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen HB 6500, The Netherlands; mathijs.binkhorst{at}


Objective To determine the validity, reliability, feasibility and applicability of a neonatal intubation scoring instrument.

Design Prospective observational study.

Setting Simulation-based research and training centre (Center for Advanced Pediatric and Perinatal Education), California, USA.

Subjects Forty clinicians qualified for neonatal intubation.

Interventions Videotaped elective intubations on a neonatal patient simulator were scored by two independent raters. One rater scored the intubations twice. We scored the preparation of equipment and premedication, intubation performance, tube position/fixation, communication, number of attempts, duration and successfulness of the procedure.

Main outcome measures Intraclass correlation coefficients (ICC) were calculated for intrarater and inter-rater reliability. Kappa coefficients for individual items and mean kappa coefficients for all items combined were calculated. Construct validity was assessed with one-way analysis of variance using the hypothesis that experienced clinicians score higher than less experienced clinicians. The approximate time to score one intubation and the instrument’s applicability in another setting were evaluated.

Results ICCs for intrarater and inter-rater reliability were 0.99 (95% CI 0.98 to 0.99) and 0.89 (95% CI 0.35 to 0.96), and mean kappa coefficients were 0.93 (95% CI 0.85 to 1.01) and 0.71 (95% CI 0.56 to 0.92), respectively. There were no differences between the more and less experienced clinicians regarding preparation, performance, communication and total scores. The experienced group scored higher only on tube position/fixation (p=0.02). Scoring one intubation took approximately 15 min. Our instrument, developed in The Netherlands, could be readily applied in the USA.

Conclusions Our scoring instrument for simulated neonatal intubations appears to be reliable, feasible and applicable in another centre. Construct validity could not be established.

  • intensive care
  • neonatology
  • resuscitation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors agree to be accountable for all aspects of the work, had full access to all of the data, and can take responsibility for the integrity and accuracy of data analysis and reporting. Study conceptualisation and design: all authors. Data collection: RNB, NKY, LPH. Data analysis and interpretation: RNB, MB, RG, MH. Drafting the initial manuscript: RNB, MB. Critical review and final approval of the manuscript: all authors.

  • Funding RNB received a scholarship from the Radboud Honours Academy to perform this study in the USA. The study was partially supported by the Endowment for the Center for Advanced Pediatric and Perinatal Education (CAPE).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board of Stanford University (ID: 36286)

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

  • Data sharing statement Tables containing all results of the ANOVAs, carried out to determine construct validity, can be obtained from the corresponding author on request.