Correlation between modified LEMON score and intubation difficulty in adult trauma patients undergoing emergency surgery

Abstract

BackgroundPrediction of difficult airway is critical in the airway management of trauma patients. A LEMON method which consists of following assessments; Look-Evaluate-Mallampati-Obstruction-Neck mobility is a fast and easy technique to evaluate patients’ airways in the emergency situation. And a modified LEMON method, which excludes the Mallampati classification from the original LEMON score, also can be used clinically. We investigated the relationship between modified LEMON score and intubation difficulty score in adult trauma patients undergoing emergency surgery.MethodsWe retrospectively reviewed electronic medical records of 114 adult trauma patients who underwent emergency surgery under general anesthesia. All patients’ airways were evaluated according to the modified LEMON method before anesthesia induction and after tracheal intubation; the intubating doctor self-reported the intubation difficulty scale (IDS) score. A difficult intubation group was defined as patients who had IDS scores > 5.ResultsThe modified LEMON score was significantly correlated with the IDS score (P < 0.001). The difficult intubation group showed higher modified LEMON score than the non-difficult intubation group (3 [2-5] vs. 2 [1-3], respectively, P = 0.017). Limited neck mobility was the only independent predictor of intubation difficulty (odds ratio, 6.15; P = 0.002).ConclusionThe modified LEMON score is correlated with difficult intubation in adult trauma patients undergoing emergency surgery.

Sternomental distance ratio as a predictor of difficult laryngoscopy: A prospective, double-blind pilot study

“…Several tests have been proposed as prognostic factors for difficult laryngoscopy[ 7 8 10 11 14 24 25 ] however none of them seems to perform well alone, and different combinations between them have been proposed to improve accuracy. [ 18 26 27 ] This is also the case of SMD which is a factor that indirectly combines mandibular space, cervical spine mobility, and neck height.…”

“…Over the years, several predictive scores for difficult airway have been proposed, with the most common being the Mallampati score,[ 7 ] the thyromental distance (TMD),[ 8 9 ] the sternomental distance (SMD),[ 10 ] the upper lip bite test (ULBT)[ 11 ] and cervical spine mobility. [ 12 13 14 ] Other factors such as body mass index (BMI)[ 15 16 ] or protruding incisors[ 17 ] have also been assessed. Despite the fact that they can be relative indicators of a difficult airway, none of them can reliably exclude difficult intubation and none of them has exhibited high sensitivity as a single test, and at most cases not even as when combined with another score.…”

“…Limited cervical spine mobility is an important factor for creating difficult intubating conditions[ 12 13 14 ] and SMD can be another indicator. [ 10 19 20 21 ] Based on personal clinical observations, we tried to combine these two factors into a new one that could at the same time, assess both patient anatomy and clinical conditions.…”

Does Video Laryngoscopy or Direct Laryngoscopy affect first pass success rates for intubation among Attending and Non-Attending Emergency Physician in the Emergency Department?

“…The greater unfamiliarity of NAEPs with endotracheal intubation likely contributed to the higher proportion of difficult intubations in this group and the larger overall number of such intubations. The LEMON score, by itself, has been shown to correlate well with difficulty of intubation 17,18 .…”

Measurement of subglottic diameter and distance to pre-epiglottic space among Chinese adults

“…Traditional screening tests for difficult airways, such as the Mallampati score, interincisor distance, thyrohyoid distance, chin-to-hyoid distance, and body mass index (BMI), have been used; however, the sensitivity and specificity have varied [11,12]. The modified Look-Evaluate-Mallampati-Obstruction-Neck mobility score has limitations in patients with severe and complex trauma, such as massive bleeding and poor visibility fields of the mouth, neck, or face [13]. The Cormack-Lehane classification is considered a useful method for prediction of difficult laryngoscopy, but it requires direct visualization of the upper airway, which may not be feasible during emergency intubations [14].…”