Inter-Observer Reproducibility of 15 Tests Used for Predicting Difficult Intubation

Adamus, Milan; Jor, Ondřej; Vavreckova, Tereza; Hrabálek, Lumir; Zapletalová, Jana; Gabrhelík, Tomáš; Tomášková, Hana; Janout, Vladimí­r

doi:10.5507/bp.2011.041

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…On the other hand, the predictive tests we used are actually measurements performed with the patient's head in a neutral or extension position, which may be achieved even passively in incapable patients. It should also be noted that the variables we studied exhibit better inter-observer reproducibility than other tests, such as head-neck mobility, which are characterised by high inter-rater variability and thus reduced predictive reliability,[33] especially in poorly cooperating patients. In the present study, in order to eliminate any bias from inter-observer variability, a single investigator performed all the pre-operative measurements.…”

Section: Discussionmentioning

confidence: 99%

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

et al. 2014

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Background and Aims:Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study.Methods:We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack–Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack–Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed.Results:Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65).Conclusions:The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.

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Section: Discussionmentioning

confidence: 99%

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

et al. 2014

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“…An extremely important attribute for any test or clinical evaluation is reliability (ie, that independent assessments by qualified observers are likely to obtain the same result). Studies of such interrater reliability have noted Mallampati score agreement in between 42% and 89% of preoperative 21,24,[47][48][49][50][51][52][53] or dental clinic 54 adults (Table). k Statistics fall well short of strong agreement (Table).…”

Section: How Reliable Is the Mallampati Score?mentioning

confidence: 99%

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

Green

Roback

2019

Annals of Emergency Medicine

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We review the literature in regard to the accuracy, reliability, and feasibility of the Mallampati score as might be pertinent and applicable to emergency department (ED) airway management and procedural sedation. This 4-level pictorial tool was devised to predict difficult preoperative laryngoscopy and intubation, but is now also widely recommended as a routine screening element before procedural sedation. The literature evidence demonstrates that the Mallampati score is inadequately sensitive for the identification of difficult laryngoscopy, difficult intubation, and difficult bag-valve-mask ventilation, with likelihood ratios indicating a small and clinically insignificant effect on outcome prediction. Although it is important to anticipate that patients may have a difficult airway, there is no specific evidence that the Mallampati score augments or improves the baseline clinical judgment of a standard airway evaluation. It generates numerous false-positive warnings for each correct prediction of a difficult airway. The Mallampati score is not reliably assessed because independent observers commonly grade it differently. It cannot be evaluated in many young children and in patients who cannot cooperate because of their underlying medical condition. The Mallampati score lacks the accuracy, reliability, and feasibility required to supplement a standard airway evaluation before ED airway management or procedural sedation. [

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“…It should also be noted that the variables we studied exhibit better inter-observer reproducibility than other tests, such as head-neck mobility, which are characterized by high inter-rater variability and thus reduced predictive reliability, [28] especially in poorly cooperating patients. In the present study, in order to eliminate any bias from inter-observer variability, a single investigator performed all the pre-operative measurements.…”

Section: The Laryngeal Mobility (Lm)mentioning

confidence: 87%

A Prospective Study of Air Way Assessment by Simple B Ed Side Test in Indian Patients

Surekha¹,

Sonal²,

Chaula³

et al. 2015

jebmh

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Simple bedside tests for airway assessment were performed in 500 randomly selected Indian adult patients posted for surgery. The parameters studied were Thyromental distance (TMD), Inter incisor distance (IID) Sternomental distance (STMD), Ratio of height to thyromental distance (RHTMD), Laryngeal mobility (LM) and Mallampati classification. The TMD, STMD, IID, RHTMD and LM measurements were consolidated into three groups namely normal, moderate and low scores. The airway parameters were finally co-related with the Mallampati classification. The normal range of values observed in Indian patients were TMD-6-7cms, IID-4. 5-5.5 cms, STMD-14-15cms, RHTMD-18-22 and LM was good in 90% of patients assessed. The airway parameters of TMD, STMD, RHTMD, IID and LM in conjunction with Mallampati classification may be a useful routine preoperative screening test for predicting intubation difficulties in Indian population. BACKGROUND AND AIMS: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. METHODS: We studied 500 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), Sternomental Distance (STMD), Interincisior Distance (IID), Ratio of Height to Thyromental Distance (RHTMD), Mallampatti Classification (MPC), Laryngeal Mobility (LM) was calculated. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cutoff points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. RESULTS: Laryngoscopy was difficult in 11% of the patients. The cutoff values were: TMD ≤6.5 cm, STMD ≤15 cm, IID≤3.5cm, MPC grade 3 & 4, and laryngeal motility judged as good, restricted and nil. The laryngeal motility had highest specificity (90%), while TMD had highest specificity (85.4%). The area under curve (AUC) for the TMD, STMD, IID, LM, MPC was 0.64, 0.63, 0.61 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P <0.001). CONCLUSIONS: The TMD, STMD, RHTMD and IID were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy

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Inter-Observer Reproducibility of 15 Tests Used for Predicting Difficult Intubation

Cited by 17 publications

References 19 publications

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

A Prospective Study of Air Way Assessment by Simple B Ed Side Test in Indian Patients

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