The diagnostic validity of clinical airway assessments for predicting difficult laryngoscopy using a grey zone approach

Jeong Jin Min, Gahyun Kim, Eunhee Kim, Jong-Hwan Lee, Jeong Jin Min, Gahyun Kim, Eunhee Kim, Jong-Hwan Lee

Abstract

Objectives: The diagnostic validity of clinical airway assessment tests for predicting difficult laryngoscopy in patients requiring endotracheal intubation were evaluated using receiver operating characteristic (ROC) curve analysis and a grey zone approach.

Methods: In this prospective observational study, patients were evaluated during a pre-anaesthetic visit. Predictive airway assessment tests (i.e. Modified Mallampati [MMT] classification; upper lip bite test [ULBT]; mouth opening; sternomental distance; thyromental distance [TMD]; neck circumference; neck mobility; height to thyromental distance [HT/TMD]; neck circumference-to-thyromental distance [NC/TMD]) were performed on each patient and LEMON, Naguib, and MACOCHA scores were also calculated. In addition, laryngeal images were acquired and assessed for percentage of glottic opening (POGO) scores. A POGO score of zero was categorized as difficult laryngoscopy.

Results: The incidence of difficult laryngoscopy was 14.4% (35/243). Although seven predictive airway assessments (i.e. MMT classification, ULBT, mouth opening, HT/TMD, NC/TMD, and the LEMON and Naguib models) predicted difficult laryngoscopy by ROC analyses, a grey zone approach showed that the parameters were inconclusive in approximately 70% of patients. From all the tests, the HT/TMD ratio showed the highest sensitivity (80.0%) and ULBT had the highest specificity (95.2%).

Conclusion: Using the grey zone approach, all predictive airway assessment tests showed large inconclusive zones which may explain previous inconsistent results in the prediction of difficult laryngoscopy. Our results suggest that the usefulness of clinical airway evaluation tests for predicting difficult laryngoscopy remains controversial.

Clinical trial registration: ClinicalTrials.gov (NCT01719848).

Keywords: Airway assessment; difficult laryngoscopy; grey zone.

© The Author(s) 2016.

Figures

Figure 1.
Figure 1.
Photographs showing (A) an AV® scope preloaded with a Macintosh laryngoscope blade, size 3; (B) laryngeal exposure with endotracheal tube placement using the AV® scope; and (C) a laryngeal image obtained during endotracheal intubation using a AV scope.
Figure 2.
Figure 2.
Flow diagram showing the patient (n = 263) progression through this prospective, observational study. Of the 263 patients who were enrolled, 20 were excluded, leaving 243 patients included in the analysis.

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Source: PubMed

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