Assessment of laryngeal view: Percentage of glottic opening scorevs Cormack and Lehane grading

Abstract

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...

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“…Failed intubation was defined as either esophageal intubation or exceeding the 120-sec time limit for performing the procedure. The percentage of glottis opening (POGO) scale 13 describes the extent to which the glottic opening was visible. A POGO scale of 100% indicates visualization of the entire glottic opening from the anterior commissure of the vocal cords to the interarytenoid notch.…”

“…Les donne´es suivantes ont e´te´mesure´es et enregistre´es : temps jusqu'a`intubation trache´ale re´ussie (crite`re d'e´valuation principal), taux de re´ussite global, temps jusqu'a`visualisation des cordes vocales, pourcentage d'ouverture glottique, compression dentaire et facilited 'intubation. Résultats Dans les cas de voies ae´riennes normales, les temps (moyenne [e´cart interquartile]) jusqu'a`intubation trache´ale e´taient plus courts avec le Pentax-AWS (12,1 [10,1-14,4] sec) et le GlideScope (14,3 [12,[4][5][6][7][8][9][10][11][12][13][14][15][16][17]6] sec) qu'avec le laryngoscope Macintosh (16,5 [13,,1] sec) (P \ 0,03 pour les deux). La diffe´rence de temps entre les deux vide´olaryngoscopes n'e´tait pas significative d'un point de vue statistique.…”

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“…4 Le score de POGO est un critère d'évaluation plus sensible de la visualisation glottique. 5 Il fournit une meilleure fiabilité inter et intra observateur. Aucune différence significative de POGO n'a été objectivée entre les deux groupes.…”