Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry This study analyzed 900 cases of difficult direct laryngoscopy (DDL) in children from the Pediatric Difficult Intubation registry (PeDIR) to identify risk factors associated with complications. The overall complication rate was 22.7% and the severe complication rate was 2.6%. Multiple intubation attempts, intubation outside the operating room, and unanticipated difficult airways were associated with severe complications on multivariate analysis. The results indicate there is significant morbidity and mortality in pediatric patients with difficult direct laryngoscopy, and certain risk factors can help identify those at higher risk of severe complications.