Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices

Kv Hashim, Mary Thomas, Kv Hashim, Mary Thomas

Abstract

Background and aims: Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients.

Methods: A total of 60 diabetic patients undergoing general anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack-Lehane scores were noted. Statistical analysis was performed using Fischer exact test.

Results: Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.

Conclusion: The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.

Keywords: Diabetes; difficult intubation; limited joint mobility.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Positive palm print sign and positive prayer sign

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Source: PubMed

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