Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation

Carlson, Jestin N.; Hostler, David; Guyette, Francis X; Pinchalk, Mark; Martin‐Gill, Christian

doi:10.5811/westjem.2017.1.32938

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…There were 218 test comparisons from 92 studies for difficult laryngoscopy, 72 comparisons from 50 studies for difficult intubation, 18 comparisons from seven studies for difficult facemask ventilation and two comparisons from two studies for failed intubation. Overall, the median (IQR [range]) number of participants per study, proportion of female participants, age and body mass index were 380 (200–662 [14–103,728]), 53% (44–64% [0–100%]), 45 (39–52 ) years and 27.3 (24.8–30.0 ) kg.m −2 , respectively. All studies except four performed airway management in operating theatres, two in the pre‐hospital setting and the others occurred in emergency rooms.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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%

“…We identified further studies from references of retrieved articles and used citation tracking in Science Citation Index. The search was updated in March 2018 but we have not incorporated the results from 27 studies in this review.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…The selection of factors was associated with emergency patients. The most parsimonious model included 5 factors: a score > 3 on the Glasgow Coma Scale (GCS); limited movement of the neck; inability to palpate the neck landmarks; trismus; and blood and/or emesis in the airway [ 28 ]. Regarding ICU patients, factors related to DI resembled factors identifiable in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Predictive performance of a multivariable difficult intubation model for obese patients

Siriussawakul

Maboonyanon

Kueprakone³

et al. 2018

PLoS ONE

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BackgroundA predictive model of scores of difficult intubation (DI) may help physicians screen for airway difficulty to reduce morbidity and mortality in obese patients. The present study aimed to set up and evaluate the predictive performance of a newly developed, practical, multivariate DI model for obese patients.MethodsA prospective multi-center study was undertaken on adults with a body mass index (BMI) of 30 kg/m2 or more who were undergoing conventional endotracheal intubation. The BMI and 10 preoperative airway tests (namely, malformation of the teeth in the upper jaw, the modified Mallampati test [MMT], the upper lip bite test, neck mobility testing, the neck circumference [NC], the length of the neck, the interincisor gap, the hyomental distance, the thyromental distance [TM] and the sternomental distance) were examined. A DI was defined as one with an intubation difficulty scale (IDS) score ≥ 5.ResultsThe 1,015 patients recruited for the study had a mean BMI of 34.2 (standard deviation: 4.3 kg/m2). The proportions for easy intubation, slight DI and DI were 81%, 15.8% and 3.2%, respectively. Drawing on the results of a multivariate analysis, clinically meaningful variables related to obesity (namely, BMI, MMT, and the ratio of NC to TM) were used to build a predictive model for DI. Nevertheless, the best model only had a fair predictive performance. The area under the receiver operating characteristic curve (AUC) was 0.71 (95% confidence interval 0.68–0.84).ConclusionsThe predictive performance of the selected model showed limited benefit for preoperative screening to predict DI among obese patients.

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“…At the reception area, each patient's basal characteristics related to tracheal intubation difficulty were assessed [2][3][4][5]. These included mouth aperture size defined as the maximum interincisal distance, Mallampati score, sternomental distance (SMD) as an indicator of neck mobility, thyromental distance, and the presence of buck teeth, were assessed by an anesthesiology resident in each hospital who only participated in these examinations and did not know the patient group.…”

Section: Intervention Anesthesia and Study Outcomesmentioning

confidence: 99%

“…Limited neck movement and a short inter-incisor gap may interfere with exposure of the larynx during direct laryngoscopy and are significant risk factors for difficult tracheal intubation [1][2][3][4][5]. When glottic exposure is inadequate with a direct laryngoscope, other instruments such as intubation stylet, video laryngoscope, or fiberoptic bronchoscope can be utilized to access the larynx [6,7].…”

Section: Introductionmentioning

confidence: 99%

The effect of brief pre-anesthetic exercise therapy of jaw and neck joints on mouth opening, neck extension, and intubation conditions during induction of general anesthesia: a randomized controlled trial

et al. 2020

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Background: The effort to improve tracheal intubation process is clinically valuable. We hypothesized that a preoperative brief exercise therapy would increase mouth opening and neck extension, enhancing intubation conditions during general anesthesia. Methods: Patients undergoing general anesthesia were randomized into two groups. The exercise group performed the exercise regimen including masseter muscle massage and stretching of jaw and neck joints before anesthetic induction, while the control did not. Before (baseline) and after the intervention, we evaluated Mallampati score, mouth aperture size, and sternomental distance. After tracheal intubation, intubation difficulty scale with direct laryngoscope and oropharyngeal soft tissue injury were also evaluated. Results: A total of 138 patients completed the analysis (control = 68, exercise = 70). Baseline characteristics did not differ between groups. At anesthetic induction, there was a significant difference in Mallampati score between the two groups (P = 0.039) and the incidence of Mallampati scores of 1 was higher in the exercise group (odds ratio [95% CI]: 2.1 [1.0-4.3], P = 0.043). Mouth opening after the intervention was greater in the exercise group than in the control group (estimated difference [95% CI]: − 2.4 [− 4.8-0.1], P = 0.042) and sternomental distance was similar between the two groups (estimated difference [95% CI]: − 3.7 [− 9.0-1.7, P = 0.175). The exercise group showed less soft tissue injuries (odds ratio [95% CI]: 0.2 [0.1-0.8], P = 0.009), however, intubation difficulty scale did not differ between the study groups (P = 0.112). Conclusions: The brief pre-anesthetic exercise improved intubation conditions and enabled faster tracheal intubation with less injury to oropharyngeal soft tissue.

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Derivation and Validation of The Prehospital Difficult Airway IdentificationTool (PreDAIT): A Predictive Model for Difficult Intubation

Cited by 11 publications

References 31 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

Predictive performance of a multivariable difficult intubation model for obese patients

The effect of brief pre-anesthetic exercise therapy of jaw and neck joints on mouth opening, neck extension, and intubation conditions during induction of general anesthesia: a randomized controlled trial

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