PMID- 27268499
OWN - NLM
STAT- MEDLINE
DCOM- 20170410
LR  - 20220321
IS  - 1473-2300 (Electronic)
IS  - 0300-0605 (Print)
IS  - 0300-0605 (Linking)
VI  - 44
IP  - 4
DP  - 2016 Aug
TI  - The diagnostic validity of clinical airway assessments for predicting difficult 
      laryngoscopy using a grey zone approach.
PG  - 893-904
LID - 10.1177/0300060516642647 [doi]
AB  - 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).
CI  - (c) The Author(s) 2016.
FAU - Min, Jeong Jin
AU  - Min JJ
AD  - Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, 
      Sungkyunkwan University School of Medicine, Seoul, Korea.
FAU - Kim, Gahyun
AU  - Kim G
AD  - Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, 
      Sungkyunkwan University School of Medicine, Seoul, Korea.
FAU - Kim, Eunhee
AU  - Kim E
AD  - Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, 
      Sungkyunkwan University School of Medicine, Seoul, Korea.
FAU - Lee, Jong-Hwan
AU  - Lee JH
AD  - Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, 
      Sungkyunkwan University School of Medicine, Seoul, Korea jonghwanlee75@gmail.com.
LA  - eng
SI  - ClinicalTrials.gov/NCT01719848
PT  - Journal Article
PT  - Observational Study
DEP - 20160606
PL  - England
TA  - J Int Med Res
JT  - The Journal of international medical research
JID - 0346411
SB  - IM
MH  - Female
MH  - Humans
MH  - *Laryngoscopy
MH  - Lung/*physiopathology
MH  - Male
MH  - Middle Aged
MH  - ROC Curve
MH  - Reproducibility of Results
PMC - PMC5536638
OTO - NOTNLM
OT  - Airway assessment
OT  - difficult laryngoscopy
OT  - grey zone
EDAT- 2016/06/09 06:00
MHDA- 2017/04/11 06:00
PMCR- 2016/08/01
CRDT- 2016/06/09 06:00
PHST- 2015/09/06 00:00 [received]
PHST- 2016/03/11 00:00 [accepted]
PHST- 2016/06/09 06:00 [entrez]
PHST- 2016/06/09 06:00 [pubmed]
PHST- 2017/04/11 06:00 [medline]
PHST- 2016/08/01 00:00 [pmc-release]
AID - 0300060516642647 [pii]
AID - 10.1177_0300060516642647 [pii]
AID - 10.1177/0300060516642647 [doi]
PST - ppublish
SO  - J Int Med Res. 2016 Aug;44(4):893-904. doi: 10.1177/0300060516642647. Epub 2016 
      Jun 6.