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Usefulness of difficult airway predictors in the emergency department

Pérez Santos FJ, Hernández Salgado M, Díaz-Landeira J, Santana Domínguez M, Domínguez García P, Herrera García M

Unidad de Cuidados Intensivos. Hospital Clínico-Quirúrgico 10 de Octubre. Instituto Superior de Ciencias Médicas de la Habana. La Habana, Cuba.

Objective: To determine the usefulness of difficult airway predictors in the emergency
department and the prognostic value of some of these predictors.
Methods: A descriptive, observational study was carried out in the emergency
department over a period of 14 months. We studied patients who required intubation to
establish an airway, assessing the likelihood of difficult airway by Mallampati score,
Cormack-Lehane classification, and sternomental distance and calculating the predictive
value, sensitivity, and specificity of these variables by themselves and in combination.
Results: We identified 137 patients requiring orotracheal intubation, which was
successful in fewer than 3 attempts in 79.5% and in 5 minutes or less in 92.3%. In 98
patients we were able to assess the likelihood of difficult airway in advance. The positive
predictive value was 100% for the Mallampati score (sensitivity, 100%; specificity,
77.7%), 87.5% for the Cormack-Lehane classification (sensitivity, 98.8%; specificity,
100%), and 66.6% for the sternomental distance (sensitivity 85.7%; specificity, 96.0%).
No gender-related differences in the incidence of difficult airway were observed.
Conclusions: The Mallampati score had the best predictive value, sensitivity, and
specificity. The difficulty of an airway could usually be predicted.

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