Prediction of Difficult Tracheal Intubation: Time for a Paradigm Change

It has been suggested that predicting difficult tracheal intubation is useless because of the poor predictive capacity of individual signs and scores. The authors tested the hypothesis that an accurate prediction of difficult tracheal intubation using simple clinical signs is possible using a comput...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2012-12, Vol.117 (6), p.1223-1233
Main Authors: LANGERON, Olivier, CUVILLON, Philippe, IBANEZ-ESTEVE, Cristina, LENFANT, François, RIOU, Bruno, LE MANACH, Yannick
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Body Mass Index
Decision Making, Computer-Assisted
Female
Humans
Intubation, Intratracheal - adverse effects
Intubation, Intratracheal - methods
Intubation, Intratracheal - trends
Male
Medical sciences
Middle Aged
Predictive Value of Tests
Time Factors
Young Adult
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Summary:It has been suggested that predicting difficult tracheal intubation is useless because of the poor predictive capacity of individual signs and scores. The authors tested the hypothesis that an accurate prediction of difficult tracheal intubation using simple clinical signs is possible using a computer-assist model. In a cohort of 1,655 patients, the authors analyzed the predictive properties of each of the main signs (Mallampati score, mouth opening, thyromental distance, and body mass index) to predict difficult tracheal intubation. They built the best score possible using a simple logistic model (SCOREClinic) and compared it with the more recently described score in the literature (SCORENaguib). Then they used a boosted tree analysis to build the best score possible using computer-assisted calculation (SCOREComputer). Difficult tracheal intubation occurred in 101 patients (6.1%). The predictive properties of each sign remain low (maximum area under the receiver operating characteristic curve 0.70). Using receiver operating characteristic curve, the global prediction of the SCOREClinic (0.74, 95% CI: 0.72-0.76) was greater than that of the SCORENaguib (0.66, 95% CI: 0.60-0.72, P
ISSN:0003-3022
1528-1175
DOI:10.1097/ALN.0b013e31827537cb