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Evaluation of bedside tests and proposal of a model for predicting difficult laryngoscopy: an observational prospective study / Avaliação de testes à beira leito e proposta de modelo para prever laringoscopia difícil: estudo prospectivo observacional
Liaskou, Chara; Vouzounerakis, Eleftherios; Trikoupi, Anastasia; Staikou, Chryssoula.
  • Liaskou, Chara; General Hospital of Rethymnon. Department of Anesthesiology. Rethymnon. GR
  • Vouzounerakis, Eleftherios; Aristotle University of Thessaloniki. Medical School. Laboratory of Primary Health Care. Thessaloniki. GR
  • Trikoupi, Anastasia; George Papanikolaou General Hospital. Department of Anesthesiology. Thessaloniki. GR
  • Staikou, Chryssoula; National and Kapodistrian University of Athens. Aretaieion Hospital. Medical School. Athens. GR
Rev. bras. anestesiol ; 70(2): 125-133, Mar.-Apr. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137156
ABSTRACT
Abstract Background and

objectives:

The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model.

Methods:

This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height-to-Thyromental Distance (R-H/TMD), Neck Circumference (NC), Ratio of Neck Circumference-to-Thyromental Distance (R-NC/TMD), Hyomental Distance with head in Neutral Position (HMD-NP) and at Maximal Extension (HMD-HE), Ratio of Hyomental Distance at Maximal head extension-to-hyomental distance in neutral position (R-HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack-Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models.

Results:

A model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed high prognostic accuracy; x2(5) = 109.12, p < 0.001, AUC = 0.86, p < 0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R-NC/TMD and HMD-HE) exhibited good prognostic performance; x2(2) = 63.5, p < 0.001, AUC = 0.77, p < 0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%).

Conclusions:

A five-variable model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R-NC/TMD and HMD-HE could be useful in incapable patients. The most accurate single predictor was HE.
RESUMO
Resumo Justificativa e

objetivos:

A previsão de laringoscopia difícil se baseia em testes que avaliam as características anatômicas da face e pescoço. Nosso objetivo foi identificar os testes mais precisos e propor modelo preditivo multivariado.

Método:

Estudo observacional prospectivo incluiu 1134 pacientes e avaliou no pré-operatório Distância Tireomentoniana (DTM), Distância Esternomentoniana (DEM), razão Altura-Distância Tireomentoniana (A/DTM), Circunferência Cervical (CC), razão Circunferência Cervical-Distância Tireomentoniana (CC/DTM), Distância Hiomentoniana com a cabeça na Posição Neutra (DHM-PN) e em Extensão Máxima (DHM-EM), razão Distância Hiomentoniana com Cabeça em Extensão Máxima/Distância Hiomentoniana na posição Neutra (DHME/DHMN), Classe Mallampati (CML), Teste da Mordida do Lábio Superior (TMLS), Abertura da Boca (AB) e Extensão da Cabeça (EC). Grau Cormack-Lehane ≥ 3 foi definido como Laringoscopia Difícil. A sensibilidade, especificidade, valores preditivos positivo e negativo foram avaliados para todos os testes. A análise multivariada com regressão logística foi usada para criar modelos preditivos.

Resultados:

Um modelo incorporando CML, TMLS, EC, DHM-EM e CC/DTM demonstrou alta precisão prognóstica (x2(5) = 109,12, p < 0,001, AUC = 0,86, p < 0,001). A sensibilidade, especificidade e valor preditivo negativo foram 82,3%, 74,8% e 97,4%, respectivamente. Um segundo modelo incluindo duas medidas que não necessitavam da cooperação do paciente (CC/DTM e DHM-EM) demonstrou bom desempenho prognóstico (x2 (2) = 63,5; p < 0,001; AUC = 0,77, p < 0,001). Entre os testes individuais, EC teve a maior sensibilidade (78,5%) e valor preditivo negativo (96%).

Conclusões:

O modelo de cinco variáveis incorporando CML, TMLS, EC, DHM-EM e CC/DTM mostrou valor preditivo satisfatoriamente alto para laringoscopia difícil. Um modelo que incluísse CC/DTM e DHM-EM poderia ser útil em pacientes com incapacidade. O preditor individual mais preciso foi EC.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Models, Statistical / Point-of-Care Testing / Laryngoscopy Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male Language: English / Portuguese Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Greece Institution/Affiliation country: Aristotle University of Thessaloniki/GR / General Hospital of Rethymnon/GR / George Papanikolaou General Hospital/GR / National and Kapodistrian University of Athens/GR

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Full text: Available Index: LILACS (Americas) Main subject: Models, Statistical / Point-of-Care Testing / Laryngoscopy Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male Language: English / Portuguese Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2020 Type: Article Affiliation country: Greece Institution/Affiliation country: Aristotle University of Thessaloniki/GR / General Hospital of Rethymnon/GR / George Papanikolaou General Hospital/GR / National and Kapodistrian University of Athens/GR