Abstract. Objective: Research defining optimal methods of intubation has been limited by the lack of a validated outcome measure to assess airway visualization. The objective of this study was to develop a reliable scale for the assessment of airway visualization during endotracheal intubation. Methods: This prospective study was performed to assess the intra-and interphysician reliabilities of emergency physicians (EPs) for estimating the percentage of glottic opening (POGO) that is visualized during direct laryngoscopy. Using video images of laryngeal views obtained from a commercially available videotape, still slide images were prepared representing glottic openings ranging from 0% to 100%. Five EPs, blinded to study objective, reviewed 25 pairs of airway slides (50 slides total). For each slide, the physicians recorded the POGO and their scores using a modified Cormack-Lehane (MCL) scale, where grade I is a view of the full glottic opening, MCL grade I1 is a partial view of the glottic opening, and MCL grade III is a view of the epiglottis only. Inter-and intraphysician reliabilities were assessed using the kappa statistic (K) for MCL grade and intraclass correlation coefficient for the POGO scores. Results: For the POGO score, the degree of intrarater reliability was very good, with an intraphysician correlation of 0.85 and a n interphysician correlation of 0.74. For the MCL score, the intraphysician concordance had a K of 0.71, and interphysician concordance was also good, with a K of 0.59. Conclusion: Both the modified version of the Cormack-Lehane grading classification and the POGO score have good interphysician and intraphysician reliabilities. Because the POGO score can distinguish patients with large and small degrees of partial glottic visibility, it might provide a better outcome for assessing the difference between various intubation techniques.

Assessment of laryngeal view: Percentage of glottic opening score vs Cormack and Lehane gradingPurpose: To examine the intra-and inter-rater reliability of two methods that categorize laryngeal view during direct laryngoscopy, the Cormack-Lehane grading system and a new scale, the percentage of glottic opening (POGO) scale. Methods: Seven anesthesiologists from the University of Pennsylvania Health System viewed 25 identical pairs of slides of laryngeal views during direct laryngoscopy. Each anesthesiologist rated the 50 slides for both CormackLehane grades and POGO scores. The latter CL replaces grades I and 2 C-L grades with a percentage of glottic opening: the POGO score. Inter and intra-physician reliability for the Cormack-Lehane grades were determined using the kappa statistic analysis, comparison of POGO scores was performed using the intraclass correlation coefficients (r~). Results: The POGO score had a better inter and intra-physician reliability than the Cormack-Lehane grading system. The intra-physician reliability for the POGO score was very good with an average interclass r m value of 0.88. The inter-physician score was good with a r~ of 0.73. The Cormack-Lehane grading system had excellent intraphysician concordance (average kappa = 0.83.) but the inter-physician reliability was poor (kappa = 0.16.) Conclusion: The Cormack-Lehane grading system has very poor inter-physician reliability. The lack of interphysician reliability with Cormack-Lehane grading calls into question the results of previous studies in which different laryngoscopists used this method to assess laryngeal view. The POGO score appears to have good intra and inter-rater reliability. It has several theoretical advantages and may prove to be more useful for research studies in direct laryngoscopy. Object]f: Wrifler la fiabilit~ intra et interobservateur de deux m~thodes de classification de la vue du larynx pendant la laryngoscopie directe : le syst~me de cotation de Cormack-Lehane et une nouvelle &helle, le pourcentage d'ouverture glottique (POG). M~thode : Sept anesth&iologistes de I'University of Pennsylvania Health System ont visionn~ 25 paires identiques de diapositives du larynx sous laryngoscopie directe. Chaque anesth&iologiste a cot~ les 50 diapositives selon les &helons Cormack-Lehane et les scores POG. Cette derni&e &helle remplace les rangs I et 2 C-L par un pourcentage d'ouverture glottique : le score POG. La fiabilit~ inter et intraobservateur des rangs CormackLehane a ~t~ d&ermin& par une analyse statistique kappa, la comparaison des scores POG a ~t~ r~alis~e en utilisant des coefficients de correlation interclasses (r~). R~ltats : Le POG a foumi une meilleure fiabilit~ inter et intraobservateur que le syst~me de cotation CormackLehane. La fiabilit~ intraobservateur du score POG a ~t~ tr~s bonne, la valeur interdasse moyenne r~ ~tant de 0,88. Le score interobservateur a &~ bon selon un r~ de 0,73. Le syst~me de Cormack-Lehane a donn~ une excellente concordance intraobservateur (kappa moyen = 0,83) mais la fiabilit~ in...

RationalePrevious studies have demonstrated that chronic obstructive pulmonary disease (COPD) causes increased mortality in the general population. But life expectancy and the years of life lost have not been reported.ObjectivesTo quantify mortality, examine how it varies with age, sex, and other risk factors, and determine how life expectancy is affected.MethodsWe constructed mortality models using the Third National Health and Nutrition Examination Survey, adjusting for age, sex, race, and major medical conditions. We used these to compute life expectancy and the years of life lost.Measurements and main resultsPulmonary function testing classified patients as having Global Initiative on Obstructive Lung Disease (GOLD) stage 0, 1, 2, 3 or 4 COPD or restriction. COPD is associated with only a modest reduction in life expectancy for never smokers, but with a very large reduction for current and former smokers. At age 65, the reductions in male life expectancy for stage 1, stage 2, and stages 3 or 4 disease in current smokers are 0.3 years, 2.2 years, and 5.8 years. These are in addition to the 3.5 years lost due to smoking. In former smokers the reductions are 1.4 years and 5.6 years for stage 2 and stages 3 or 4 disease, and in never smokers they are 0.7 and 1.3 years.ConclusionsPersons with COPD have an increased risk of mortality compared to those who do not, with consequent reduction in life expectancy. The effect is most marked in current smokers, and this is further reason for smokers to quit.

Rationale: Exposure to lifestyle, occupational, and environmental risk factors for cancer are undoubtedly different in cerebral palsy (CP) than in the general population, and these and other differences may result in a specific pattern of cancer mortality in CP. Objective: To study the cancer mortality of CP in California. Study group: 40,482 CP cases (contributing 357,928 personyears) among 210,155 persons having received annual evaluations from the California Department of Developmental Services over the period 1988-2002 were followed. Methods: Mortality due to malignant and non-malignant neoplasms (ICD9 codes 140-239) in CP was compared with that in the California general population using age-and gender-standardized mortality ratios (SMRs). Results: An excess of mortality due to malignant neoplasms (SMR 1.31, 95% CI 1.14-1.51) was found. Cancer mortality was elevated in CP for some sites, and other cancer deaths were underrepresented in CP. Deaths due to cancer of the esophagus (SMR = 5.40, 95% CI 3.bladder (4.57, 2.09-8.68) were significantly overrepresented in CP, while deaths due to cancer of the trachea, bronchus and lung were underrepresented (0.22, 0.09-0.43). Conclusion: Cancer mortality in cerebral palsy has specific differences with the population at large, and these differences may illuminate important contributing behavioral, environmental, or health care factors.