Do adult predictive tests predict difficult intubation in children?

Baudouin, Laure; Bordes, M.; Merson, Laura; Naud, Julien; Semjen, F.; Cros, A. M.

doi:10.1097/00003643-200606001-00586

Cited by 9 publications

(4 citation statements)

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“…Thyromental distance was observed to have a moderate sensitivity (63.6%), and a high speci city (95.8%), NPV (93.4%), PPV (73.7%), and a diagnostic accuracy (82.2%) in our study. Unlike adults, there are still no xed lowest acceptable values for TMD and RHTMD in children, though it will be considerably smaller [27]. According to our study, the cut-off points of TMD was 5cm in predicting di cult laryngoscopy by ROC curve analysis.…”

Section: Discussionmentioning

confidence: 52%

Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5-12 years old at selected Addis Ababa governmental hospitals, Ethiopia: A multicenter cross-sectional study.

Sitot

Amare

Aregawi

2022

Preprint

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Background: Maintaining patent airways is vital in pediatric anesthetic management. Failure to manage and anticipate difficult laryngoscopy preoperatively is the leading cause of morbidity and mortality. Data on the predictive values of screening parameters in predicting difficult laryngoscopy (DL) are limited in children. Therefore, this study aimed to assess the predictive value of the modified Mallampati test (MMT), upper lip bite test (ULBT), thyromental distance (TMD), and ratio of height to thyromental distance (RHTMD) in predicting DL in children aged 5-12 years at selected Addis Ababa governmental hospitals in Ethiopia.Methods: A multicenter cross-sectional study was conducted on 141 elective pediatric surgical patients aged 5 to 12 years selected using a systematic random sampling technique from December 1, 2021, to April 30, 2022. Data were collected using structured questionnaires. The collected data were entered and analysed by SPSS version 26. Fisher’s exact test and receiver operating characteristic curve analysis were used to compare the accuracy of MMC, ULBT, TMD, and RHTMD against difficult laryngoscopy. A P value <0.05 was considered statistically significant.Results: The magnitude of difficult laryngoscopy was 15.6%. MMT has the highest sensitivity (86.4%), specificity (91.6%), and negative predictive value (NPV) (97.3%) compared to other tests. The ULBT also has a high sensitivity (72.7%), specificity (84%), and NPV (94.3%) with comparable diagnostic accuracy (90.8%) with the MMT (P<0.05). The sensitivity, specificity, positive predictive value (PPV), NPV, and accuracy of TMD were 63.6%, 95.8%, 73.7%, 93.4%, and 82.2%, respectively. The RHTMD has the lowest specificity (63.6%), PPV (22.5%), NPV (91.4%), and accuracy (56.7%) in predicting difficult laryngoscopy.Conclusion: The MMT and ULBT are good screening tests, followed by the TMD in predicting DL, while the RHTMD was the least accurate predictor. Because no single test has 100% predictive value, a combination of screening tests is advised in pediatrics for predicting difficult laryngoscopy.

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Section: Discussionmentioning

confidence: 52%

Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5-12 years old at selected Addis Ababa governmental hospitals, Ethiopia: A multicenter cross-sectional study.

Sitot

Amare

Aregawi

2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Thyromental distance was observed to have moderate sensitivity (63.6%), high specificity (95.8%), NPV (93.4%), PPV (73.7%), and diagnostic accuracy (82.2%) in our study. Unlike adults, there are still no fixed lowest acceptable values for TMD and RHTMD in children, although it will be considerably smaller [ 29 ]. According to our study, the cut-off point of TMD was 5 cm in predicting DL by ROC curve analysis.…”

Section: Discussionmentioning

confidence: 99%

Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5–12 years old at selected Addis Ababa governmental hospitals, Ethiopia: a multicenter cross-sectional study

2022

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Background Maintaining patent airways is vital in pediatric anesthetic management. Failure to manage and anticipate difficult laryngoscopy (DL) preoperatively is the leading cause of morbidity and mortality. Data on the predictive values of screening parameters in predicting DL are limited in children. Therefore, this study aimed to assess the predictive value of the modified Mallampati test (MMT), upper lip bite test (ULBT), thyromental distance (TMD), and ratio of height to thyromental distance (RHTMD) in predicting DL in children aged 5–12 years at selected Addis Ababa governmental hospitals in Ethiopia. Methods A multicenter cross-sectional study was conducted on 141 elective pediatric surgical patients aged 5 to 12 years selected using a systematic random sampling technique at three governmental hospitals from December 1, 2021, to April 30, 2022. The collected data were entered and analysed by SPSS version 26. Chi-square and Fisher’s exact tests were used to compare categorical variables. The receiver operating characteristic curve analysis was used to compare the accuracy of MMT, ULBT, TMD, and RHTMD against DL. A P value < 0.05 was considered statistically significant. Results The magnitude of DL was 15.6%. MMT has the highest sensitivity (86.4%), specificity (91.6%), and negative predictive value (NPV) (97.3%) compared to other tests. The ULBT also has a high sensitivity (72.7%) and specificity (84%) with comparable diagnostic accuracy (90.8%) with the MMT (P < 0.05). The sensitivity, specificity, positive predictive value (PPV), NPV, and accuracy of TMD were 63.6%, 95.8%, 73.7%, 93.4%, and 82.2%, respectively. The RHTMD has the lowest specificity (63.6%), PPV (22.5%), NPV (91.4%), and accuracy (56.7%) in predicting DL. Conclusion The MMT and ULBT are good screening tests, followed by the TMD in predicting DL, while the RHTMD was the least accurate predictor. Because no single test has 100% predictive value, a combination of screening tests is advised in pediatrics for predicting DL.

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“…Baudouin et al showed that the Mallampati test and mouth opening were not predictive tests for difficult intubation in children less than 18 months ( 20 ). Aggarwal et al found that the interincisor gap (MO) seemed to be an inadequate predictor of difficult intubation in children ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

et al. 2021

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Background: Tracheal intubation is the most reliable way of securing an airway. Pediatric airway management is one of the significant challenges, especially for non-pediatric anesthesiologists. Early airway evaluation for detecting difficult intubation and preventing catastrophic events is necessary before anesthesia, especially in children. Objectives: Therefore, this study was done to compare some valuable adult predictors in children under two years of age. Methods: This prospective descriptive-analytical study was performed on 405 children under two years of age that were referred for elective surgery under general anesthesia with endotracheal intubation in Imam Hossein Hospital, Isfahan. Under sedation in a supine position, we measured items, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). An expert anesthesiologist did laryngoscopy and intubation, and difficult cases were recorded. Results: Our study showed that the frequency of difficult intubation with IDS > 4 was %16, and with IDS > 5 was %3. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation. The cut-off points for age < 6 months, weight < 5/9 kg, height < 61 cm, and SMD < 5/3 cm were obtained, respectively. Other variables, such as MO, AASI, NC, and sex, were unreliable predictors for difficult intubation. Conclusions: We found that IDS > 4, age< 6-month, weight < 5/9 kg, and SMD < 5/3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictions before anesthesia is started to find who has difficult intubation.

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Do adult predictive tests predict difficult intubation in children?

Cited by 9 publications

References 0 publications

Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

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