A Comparison of Wilson Sum Score and Combination Mallampati, Tiromental and Sternomental Distances for Predicting Difficult Intubation

Domi, Rudin

doi:10.3889/mjms.1857-5773.2009.0045

Cited by 19 publications

(16 citation statements)

References 9 publications

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“…Furthermore, laryngoscopy proved simple in another two patients who had a Wilson score of ≥4. These results appear to be in line with the findings of Domi [10], published in 2009, in which the Wilson score successfully predicted 82.5% of cases of difficult airway, a better result than the 22.5% found when the Mallampati classification was used in conjunction with the thyromental and sternomental distances.…”

Section: Discussionsupporting

confidence: 91%

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Wanderley¹,

Lima²,

Couceiro³

et al. 2013

OJAnes

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Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway; its specificity, however, is low.

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Section: Discussionsupporting

confidence: 91%

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Wanderley¹,

Lima²,

Couceiro³

et al. 2013

OJAnes

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“…). After detailed assessment, we included 133 studies (127 cohort type and six case–control) involving 844,206 participants . Of the 133 studies, there were six for the Mallampati test, 105 for the modified Mallampati test, six for Wilson risk score, 52 for thyromental distance, 18 for sternomental distance, 34 for the mouth opening test and 30 for the upper lip bite test.…”

Section: Resultsmentioning

confidence: 99%

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

et al. 2019

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Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); thyromental distance (52 studies); sternomental distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41; p < 0.001) and thyromental distance (0.24, 0.12-0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.

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“…Patients were randomly allocated to 3 groups (with 40 patients in each) by the random number table method: group D underwent laryngoscopy with the DL, group S with the SOS and group G with the GVL. Inclusion criteria were: males and females between 35 and 60 years of age, a body weight of between 42 and 76 kg, BMI <30, an American Society of Anesthesiology physical status I-II and a comprehensive airway difficulty score >5 upon assessment (table 1 ) [ 17 ]. Exclusion criteria were: acute inflammation of the throat, a history of gastroesophageal reflux disease, hematological disease or drug allergy or abnormalities in the heart, lungs, liver or kidneys.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Three Tracheal Intubation Techniques in Thyroid Tumor Patients with a Difficult Airway: A Randomized Controlled Trial

Liu

Yue

2014

Med Princ Pract

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Objective: To investigate the effectiveness of the Shikani optical stylet (SOS) and GlideScope video laryngoscope (GVL) for tracheal intubation of thyroid tumor patients with a difficult airway. Subjects and Methods: One hundred and twenty thyroid tumor patients with a difficult airway, who were undergoing elective surgery requiring general anesthesia, were enrolled in the study. They were randomly allocated to 3 groups (n = 40 each) who underwent direct laryngoscopy (DL), SOS or GVL. The outcomes recorded were time to intubation, first-attempt success rate, mean artery pressure (MAP), heart rate (HR) and incidence of complications. Results: The mean time to intubation in the SOS group (group S; 42.4 ± 24.1 s) and the GLV group (group G; 29.8 ± 22.3 s) was significantly less than that in the DL group (group D) (68.8 ± 26.6 s). The first-attempt success rate in group S (90.0%) and group G (97.5%) was significantly higher than that in group D (75.0%; all p < 0.05). The HR and MAP at 1 min after intubation were lowest in group S (76.4 ± 9.2 beats/min and 12.9 ± 1.1 kPa), followed by group G (79.9 ± 9.3 beats/min and 13.0 ± 0.9 kPa) and then group D (90.4 ± 8.1 beats/min and 16.6 ± 1.2 kPa). The difference was statistically significant (all p < 0.05). The incidence of lip or mucosal trauma was lowest in group S, followed by group G and then group D. Conclusion: The SOS and the GLV had advantages over the DL in the management of thyroid tumor patients with a difficult airway in terms of a shorter time to intubation, a higher first-attempt success rate and a reduced incidence of complications. Thus, a rational choice of one of these techniques may be better for the perioperative safety of thyroid tumor patients with a difficult airway.

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A Comparison of Wilson Sum Score and Combination Mallampati, Tiromental and Sternomental Distances for Predicting Difficult Intubation

Cited by 19 publications

References 9 publications

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review

Comparison of Three Tracheal Intubation Techniques in Thyroid Tumor Patients with a Difficult Airway: A Randomized Controlled Trial

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