Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

Selvi, Onur; Kahraman, Tugce; Şentürk, Özgür; Tulgar, Serkan; Serifsoy, Ercan; Özer, Zeliha

doi:10.1016/j.jclinane.2016.08.006

Cited by 53 publications

(84 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, a recent study re-evaluated TMH in a Turkish population and derived a best compromise at 43 mm describing a sensitivity, specificity, and NPV of 64.8%, 78%, and 96.1%, respectively. [ 3 ] The study also produced a low PPV of 20.87% and failed to show the efficacy of TMHT, as revealed by us and others. [ 1 2 ] It has to be noted, however, that their mean TMH was only 45 mm, roughly 15 mm less noted by other studies.…”

Section: Discussionmentioning

confidence: 80%

“…Using digital measurements, another source found a lower sensitivity and PPV for TMHT at 50 mm cutoff in a Turkish population. [ 3 ] Although the study produced the best compromise for sensitivity and specificity when the cutoff was lowered to 43.5 mm, the authors could not replicate the originally described efficacy of TMHT. The above-mentioned studies compared the efficacy of TMHT with modified Mallampati score, TMD, SMD, and upper lip bite test.…”

Section: Introductionmentioning

confidence: 93%

See 1 more Smart Citation

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

et al. 2018

View full text Add to dashboard Cite

Background and Aims:Thyromental height test (TMHT) is a recently described anatomical bedside screening tool in predicting difficult laryngoscopy. It has been shown to be more accurate than the modified Mallampati score, thyromental distance (TMD), and sternomental distance with regard to sensitivity and positive predictive value (PPV). Airway assessment studies based on the anatomic parameters of the upper airway are limited in the subcontinent population. We attempted this study to evaluate and validate the predictive value of TMHT at 50 mm in an Indian population in predicting difficult laryngoscopy.Methods:This prospective observational study was conducted in a tertiary teaching hospital on 340 patients. TMHT along with other bedside predictors of difficult intubation, including modified Mallampati score, interincisor gap (IIG), TMD, neck circumference (NC), and neck extension were assessed. We compared the sensitivity, specificity, PPV, negative predictive value (NPV), and diagnostic accuracy of TMHT with other bedside tests such as the modified Mallampati score, IIG, TMD, NC, and neck extension individually in predicting difficult laryngoscopy. Any Cormack and Lehane's intubation grade II b and above was considered to be difficult laryngoscopy.Results:TMHT had the highest sensitivity (84.62%) and specificity (98.97%), and had the most PPV (88%) and NPV (98.63%) when compared with the modified Mallampati score, IIG, TMD, NC, and neck extension. TMHT was followed by the modified Mallampati score and IIG.Conclusion:TMHT appears promising as a single anatomical measure to predict the risk of difficult laryngoscopy, however, validation will require further studies in more diverse patient populations.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 93%

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Other studies with high TMD were Baker et al . [ 27 ] with 6–8 cm and a study in Turkish population[ 28 ] quoting a cut off TMD of 8.2 cm. We hypothesised that in South Indian population the TMD is longer compared to height.…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and upper airway measurements: A study in South Indian population

Balakrishnan

Chockalingam

2017

Indian J Anaesth

View full text Add to dashboard Cite

Background and Aims:Most studies on upper airway are conducted based on airway measurements in the western population. We set out to find the normal values of upper airway measurements in South Indian population. The aim of this study was to perform various upper airway examinations and to set standards for normal measurements in the South Indian population as well as to analyse the data for predictors of difficult intubation.Methods:This prospective observational study was conducted in a tertiary cancer hospital in Southern India. Airway assessment parameters, including modified Mallampati classification (MPC), upper lip bite test (ULBT), sternomental distance, thyromental distance (TMD), and the inter-incisor distance were documented for 2004 patients meeting the inclusion criteria. Laryngoscopic view after induction was graded as per Cormack and Lehane's (CL) classification. Any CL ≥3 was considered to be difficult laryngoscopy. The collected data (2004 cases) was analyed with SPSS software version 17. Receiver operating characteristics (ROC) curve was used to determine cut-offs in the population. Sensitivity, specificity, positive and negative predictive value were computed.Results:MPC, ULBT, and ratio of height to TMD (RHTMD) predicted difficult intubation with sensitivity of 40.86%, 45.53% and 64.60%, respectively and these were statistically significant with P < 0.001. Using the area under the curve of the ROC curve and discrimination analysis normal RHTMD in our population had a cut off value of 17.1.Conclusion:The cut off value for RHTMD to predict difficult laryngoscopy in the South Indian population is 17.1.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

Cited by 53 publications

References 15 publications

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

Ethnicity and upper airway measurements: A study in South Indian population

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

Contact Info

Product

Resources

About