Predicting Difficult Intubation in Emergency Department by Intubation Assessment Score

Srivilaithon, Winchana; Muengtaweepongsa, Sombat; Sittichanbuncha, Yuwares; Patumanond, Jayanton

doi:10.14740/jocmr3320w

Cited by 23 publications

(30 citation statements)

References 21 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 training level of operator should be considered, so similar study excluded the case which is intubated by low experience operators, including last year of medical student and rst-year internist in general practice (45). Therefore, we only included the patients who were intubated by chief residents and attending physicians, and the GAP analysis also demonstrated that the variable of operator has almost zero correlation to all of the adverse index such as intubation injury, number of attempts, and even di cult intubation, implied that our chief residents and attending physicians have almost equal level of the skill of endotracheal intubation, so there was less experience related bias in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Other researchers have proposed combinations of these measures for precise prediction. Srivilaithona et al showed that the weighted combination of ve independent predictors (male sex, large tongue, limited mouth opening, poor neck mobility, and obstructed airway) helped to discriminate di cult intubation patients (7); however, the use of so many predictors is not suitable for ED. In this study, we evaluated the incidence and predictive factors of di cult intubation and developed an easy-to-use predictive formula for emergency physicians.…”

Section: Introductionmentioning

confidence: 99%

A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

Liao

Chang

et al. 2020

Preprint

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Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.Methods For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variables.Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p<0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR]=1.270), thyromental distance (OR=0.614), upper airway obstruction (OR=4.038), and Mallampati difficulty (OR=5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.Trial registration This 17-month (2011/11/1-2013/3/31) prospective observational study was approved by the Institutional Review Board of MacKay Memorial Hospital (11MMHISO64).

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“…The reported incidence of difficult intubation in the ED varies from 2% to 26%, owing to different study definitions and populations [10][11][12]. The incidence of our study was 35.5%, higher than previous studies, because we defined difficult intubation as Cormack & Lehane classification grade III or IV in the first intubation attempt rather than the final successful attempt [10,11]. We thought that it should be a fair comparison of different patients, and we supposed participating physicians should be well prepared before the first intubation attempt.…”

Section: Discussionmentioning

confidence: 99%

Predictors of diﬃcult endotracheal intubation in the emergency department: a single-center pilot study

2020

Signa Vitae

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Background: Identifying patients who are at risk of difficult endotracheal intubation is crucial in the emergency department. Therefore, this study evaluated the incidence and predictive factors of difficult tracheal intubation in the emergency department. Methods: This was a 17-month prospective observational study. A difficult airway was defined as Cormack & Lehane classification grades III and IV at the first attempt of intubation. Patients who visited the emergency department, underwent traditional endotracheal intubation from participating physicians, and provided informed consent by themselves or via their delegates were enrolled in this study. Univariate associations between patient characteristics and difficult endotracheal intubation were identified, and statistically significant factors were included in a multivariate binary logistic regression model. A generalized association plot was used to show the relationships between variables. Results: A total of 110 patients were enrolled in the study. The incidence of difficult intubation was 35.5% (39/110). In the difficult airway group, significantly higher body mass index (BMI), and incidence of double chin, thick short neck, Mallampati difficulty, small interincisor distance, small thyromental distance, and upper airway obstruction were noted on univariate analysis. A predictive formula for difficult tracheal intubation was successfully established by the combination of four independent predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cutoff score of four maximized Youden’s index, providing sensitivity (79.5%) and specificity (81.7%) (95% CI: 0.794 to 0.938). Conclusions: We used four predictors of difficult tracheal intubation, namely, BMI, thyromental distance, upper airway obstruction, and Mallampati difficulty, to create a predictive formula. This formula could help emergency physicians to quickly identify and carefully manage patients with difficult endotracheal intubation and consult experts early if necessary.

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Predicting Difficult Intubation in Emergency Department by Intubation Assessment Score

Cited by 23 publications

References 21 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

A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

Predictors of diﬃcult endotracheal intubation in the emergency department: a single-center pilot study

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