Airway Assessment for Anticipation of Difficult Intubation: A Double Blind Comparative Study

Reghunathan, Ushakumary; Raghavan, Radha Korumbil; Veetil, Bindu Mele

doi:10.14260/jemds/2016/575

Cited by 2 publications

(1 citation statement)

References 13 publications

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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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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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Airway physical examination tests for detection of difficult airway management in apparently normal adult patients

Roth

Pace

Lee

et al. 2018

Cochrane Database of Systematic Reviews

155

146

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BackgroundThe unanticipated di icult airway is a potentially life-threatening event during anaesthesia or acute conditions. An unsuccessfully managed upper airway is associated with serious morbidity and mortality. Several bedside screening tests are used in clinical practice to identify those at high risk of di icult airway. Their accuracy and benefit however, remains unclear. ObjectivesThe objective of this review was to characterize and compare the diagnostic accuracy of the Mallampati classification and other commonly used airway examination tests for assessing the physical status of the airway in adult patients with no apparent anatomical airway abnormalities. We performed this individually for each of the four descriptors of the di icult airway: di icult face mask ventilation, di icult laryngoscopy, di icult tracheal intubation, and failed intubation. Search methodsWe searched major electronic databases including CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, as well as regional, subject specific, and dissertation and theses databases from inception to 16 December 2016, without language restrictions. In addition, we searched the Science Citation Index and checked the references of all the relevant studies. We also handsearched selected journals, conference proceedings, and relevant guidelines. We updated this search in March 2018, but we have not yet incorporated these results. Selection criteriaWe considered full-text diagnostic test accuracy studies of any individual index test, or a combination of tests, against a reference standard. Participants were adults without obvious airway abnormalities, who were having laryngoscopy performed with a standard laryngoscope and the trachea intubated with a standard tracheal tube. Index tests included the Mallampati test, modified Mallampati test, Wilson risk score, thyromental distance, sternomental distance, mouth opening test, upper lip bite test, or any combination of these. The target condition was di icult airway, with one of the following reference standards: di icult face mask ventilation, di icult laryngoscopy, di icult tracheal intubation, and failed intubation. Airway physical examination tests for detection of di icult airway management in apparently normal adult patients (Review)

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Airway Assessment for Anticipation of Difficult Intubation: A Double Blind Comparative Study

Cited by 2 publications

References 13 publications

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

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

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients

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