Purpose: To identify the variables most useful in predicting dill]cult laryngoscopy and intubation from various dinical, skeletal (lateral x-rays) and soft tissue (three-dimensional computed tomography imaging) measurements. Methods: Twenty-four adult patients in whom an unanticipated difficult tracheal intubation was identified according to established criteria were evaluated. Further, a control group of 32 patients in whom tracheal intubation was easily accomplished was studied. We applied multivariate discriminant analysis to clinical and radiological data of all patients to select those variables most useful in predicting difficult laryngoscopy and intubation. The receiver operating characteristic (ROC) curve was used to describe the discrimination abilities and to explore the trade-offs between sensitivity and specificity of the model. Re.tits: VCCh the clinical data alone, discriminant analysis identified four risk factors that correlated with the prediction of difficult laryngoscopy and intubation: thyrostemal distance, thyromental distance, neck circumference and Mallampati classification, W~h both clinical and radiological data, discriminant analysis identified five risk factors: thyrostemal distance, thyromental distance, Mallampati classification, depth of spine C2 and angle A (the most antero-inferior point of the upper central incisor tooth). The positive predictive value of this combined (clinical and radiological) model was greater than that of the clinical model alone (95.8% vs 87.5%, respectively). The areas under the ROC curves, that measure the probability of the correct prediction of the clinical and the combined models, were found to be 0,933 and 0.973, respectively. Conclusions: These models can be used for predicting difficult laryngoscopy and intubation in clinical practice.Objectif: Identifier les variables les plus utiles servant ~ pr~.dire des difficult& de laryngoscopie et d'intubation ~ partir de diverses mesures cliniques, squelettiques (radiographies de profil) et des tissus mous (tomodensitom&rie en trois dimensions). M&hode : On a ~valu6 44 patients adultes pouvant pr&enter, selon des crit&es reconnus, une intubation endotrach~ale difficile impr~vue. En contrepartie, on a &udi~ un groupe t~moin de 32 patients chez qui l'intubation avait ~t~ facilement r~alis~e, l'analyse multifactorielle discriminante des donn~es cliniques et radiologiques de tousles patients a permis de s~lectionner les variables les plus utiles pour pr~dire la laryngoscopie et rintubation difficiles. L:analyse par les courbes ROC (Receiver Operating Characteristic) a ~t~ utilis~e pour d&rire les possibitit& de discrimination et explorer les recoupements entre la sensibilite et la sp&ificit~ du modele. R~ultats : I'analyse discriminante des donn~es cliniques permet d'identifier quatre facteurs de risque en correlation avec la prediction de laryngoscopie et d'intubation difficiles : la distance thyrostemale, la distance thyromentonni&e, le p&im&re du cou et la classification de Mallampati. [:analyse des donn&s di...
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