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.
Background: In recent years, there has been a growing interest in understanding the role of prognostic factors in patient outcome.Aim: To investigate the role of clinical indicators, and severity-of-disease assessment scales, as prognostic factors in the outcome of multi-trauma patients in the ICU.Material and Method: The sample consisted of 65 ICU multi-trauma patients treated in a hospital in Thessaloniki city, with an average stay of 16.5 days. Clinical indicators such as Glasgow Coma Scale, heart rate, mean arterial pressure, lactic acid, hemoglobin, urine output, as well as APACHE II and SAPS II scales, were recorded on the day of admission to the ICU.Data analysis: Data were analyzed using multiple logistic regression and Mann-Whitney Test. Multiple logistic regression analysis was performed to examine the predictive capacity of specific indicators on patient outcome.Results: The results of the analysis showed that in cases where all clinical indicators changed, then patient outcome may be affected by 79,4% (Relative Risk 3.846, p<0.001). Glasgow Coma Scale (p=0.022) and hemoglobin (p=0.013) were the strongest influencing factors related to patient outcome. Mann-Whitney analysis was used to evaluate the predictive value of Apache II and SAPS II and demonstrated that both systems could significantly predict patient outcome (APACHE II=0.019 and SAPS II=0.013).Conclusion: Hemoglobin and Glasgow Coma Scale values upon multi-trauma patient admission to the ICU appear to be strong prognostic factors of patient outcome.
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