The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

Min, Jeong Jin; Kim, Ga Hyun; Kim, Eun‐Hee; Lee, Jong‐Hwan

doi:10.1177/0300060516642647

Cited by 16 publications

(14 citation statements)

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“…[ 32 ] While many airway examinations are statistically significant by ROC analysis, using the grey zone approach shows large inconclusive zones that possibly explain the inconsistent results in predicting diffcult laryngoscopy. [ 33 ]…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan

Chockalingam

2017

Indian J Anaesth

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Background and Aims:Most studies on upper airway are conducted based on airway measurements in the western population. We set out to find the normal values of upper airway measurements in South Indian population. The aim of this study was to perform various upper airway examinations and to set standards for normal measurements in the South Indian population as well as to analyse the data for predictors of difficult intubation.Methods:This prospective observational study was conducted in a tertiary cancer hospital in Southern India. Airway assessment parameters, including modified Mallampati classification (MPC), upper lip bite test (ULBT), sternomental distance, thyromental distance (TMD), and the inter-incisor distance were documented for 2004 patients meeting the inclusion criteria. Laryngoscopic view after induction was graded as per Cormack and Lehane's (CL) classification. Any CL ≥3 was considered to be difficult laryngoscopy. The collected data (2004 cases) was analyed with SPSS software version 17. Receiver operating characteristics (ROC) curve was used to determine cut-offs in the population. Sensitivity, specificity, positive and negative predictive value were computed.Results:MPC, ULBT, and ratio of height to TMD (RHTMD) predicted difficult intubation with sensitivity of 40.86%, 45.53% and 64.60%, respectively and these were statistically significant with P < 0.001. Using the area under the curve of the ROC curve and discrimination analysis normal RHTMD in our population had a cut off value of 17.1.Conclusion:The cut off value for RHTMD to predict difficult laryngoscopy in the South Indian population is 17.1.

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Section: Discussionmentioning

confidence: 99%

Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan

Chockalingam

2017

Indian J Anaesth

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“…The commonly used standard for difficult laryngoscopy is a Cormack-Lehane direct laryngeal view classification of grade III or IV, 5,23,[25][26][27][28][29][30][31] although the percentage of glottic opening score has also been used. 32 When the chosen outcome is instead difficult intubation, this has been coded as either a numeric threshold (eg, 3 or more unsuccessful attempts 26 ) or a composite score based on the number of attempts and ultimate intubation failure. 31,33 Adults receiving general anesthesia…”

Section: How Well Does the Mallampati Score Predict Difficult Laryngomentioning

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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“…[2,3] To date, observational methods such as the mod- to predict difficult intubation in adult patients. [4][5][6] However, there are a limited number of studies in the literature regarding the use of such diagnostic tests in the pediatric population. [7][8][9][10][11] In the present study, compared with the Cormack-Lehane classification, the effectiveness of widely used bedside tests including MMT and ULBT and anthropometric measurements of the head and neck was examined to predict difficult airway status in pediatric patients under general anesthesia.…”

Section: Introductionmentioning

confidence: 99%

“…Forty-eight pediatric patients with a mean age of 6.1 years(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) were included in the study. There were 27(56.2%) males and 21 (43.8%) females.…”

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confidence: 99%