Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar-Apr;73(2):153-158.
doi: 10.1016/j.bjane.2021.07.028. Epub 2021 Aug 16.

A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adult patients

Gustavo P Bicalho  1 , Roberto C Bessa Jr  2 , Marcos Guilherme C Cruvinel  2 , Fabiano S Carneiro  2 , Jayme B Castilho  2 , Carlos Henrique V Castro  2
Affiliations

A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adult patients

Gustavo P Bicalho et al. Braz J Anesthesiol. 2023 Mar-Apr.

Abstract

Purpose: Several bedside clinical tests have been proposed to predict difficult tracheal intubation. Unfortunately, when used alone, these tests show less than ideal prediction performance. Some multivariate tests have been proposed considering that the combination of some criteria could lead to better prediction performance. The goal of our research was to compare three previously described multivariate models in a group of adult patients undergoing general anesthesia.

Methods: This study included 220 patients scheduled for elective surgery under general anesthesia. A standardized airway evaluation which included modified Mallampati class (MM), thyromental distance (TMD), mouth opening distance (MOD), head and neck movement (HNM), and jaw protrusion capacity was performed before anesthesia. Multivariate models described by El-Ganzouri et al., Naguib et al., and Langeron et al. were calculated using the airway data. After anesthesia induction, an anesthesiologist performed the laryngoscopic classification and tracheal intubation. The sensitivity, specificity, and receiver operating characteristic (ROC) curves of the models were calculated.

Results: The overall incidence of difficult laryngoscopic view (DLV) was 12.7%. The area under curve (AUC) for the Langeron, Naguib, and El-Ganzouri models were 0.834, 0.805, and 0.752, respectively, (Langeron...>...El-Ganzouri, p...=...0.004; Langeron...=...Naguib, p...=...0.278; Naguib...=...El-Ganzouri, p...=...0.101). The sensitivities were 85.7%, 67.9%, and 35.7% for the Langeron, Naguib, and El-Ganzouri models, respectively.

Conclusion: The Langeron model had higher overall prediction performance than that of the El-Ganzouri model. Additionally, the Langeron score had higher sensitivity than the Naguib and El-Ganzouri scores, and therefore yielded a lower incidence of false negatives.

Keywords: Airway management; Anesthesiology; Intubation; Laryngoscopy; Predictive value of tests.

PubMed Disclaimer

Figures

Figure 1
Figure 1
ROC curves of the three multivariate models studied.
See this image and copyright information in PMC

References

    1. Kelly FE, Cook TM. Seeing is believing: getting the best out of videolaryngoscopy. Br J Anaesth. 2016;117 Suppl 1:i9–i13. - PubMed
    1. Cook T.M., Woodall N., Frerk C., Project F.N.A. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–631. - PubMed
    1. Frerk C., Mitchell V.S., McNarry A.F., et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–848. - PMC - PubMed
    1. Apfelbaum J.L., Hagberg C.A., Caplan R.A., et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–270. - PubMed
    1. Mallampati S.R., Gatt S.P., Gugino L.D., et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32:429–434. - PubMed

LinkOut - more resources