Comparison of four methods for predicting difficult intubation

2016 ◽  
Vol 5 (01) ◽  
pp. 4720
Author(s):  
Javaher Foroosh Zadeh F ◽  
Safaii Sara
Keyword(s):  
Difficult Intubation ◽  
Elective Surgery ◽  
Upper Lip ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Significant Difference ◽  
Combined Test ◽  
Predicted Values ◽  
Sensitivity Specificity ◽  
A Prospective Study

Confirmation of endotracheal tube appointment is of critical importance, since unrecognized esophageal intubation can be rapidly lethal (death, brain damage). The aim of our study was to compare four different methods for prediction of difficult intubation: Mallampati, Thyro-mental distance, ULBT (Upper Lip Bite Test), and Inter incisicor gap. In a prospective study, 448 patients with a mean age of 53.5 who were scheduled for elective surgery were selected randomly and enrolled. Before induction of anesthesia, the airways were assessed by Mallampati test, Thyro mental distance, Upper lip bit test(ULBT) and Inter incisor gap. Laryngoscopic view according to the Cormack and Lehane grading system was determined after induction of anesthesia and Grades 3 and 4 defined as “difficult intubation.” Degree of observed difficulty of intubation was compared to predicted values. Sensitivity, specificity, positive and negative predictive values and accuracy of these tests and their combinations with the ULBT were calculated. Statistical analysis was performed using SPSS version 16. Data were analysis by using Fishers exact and McNemar's test, and a Pvalue. <0.05 was considered statistically significant.  The prevalence of difficult intubation Cormack-Lehane in this study was 8.4%, Mallampati test had the highest sensitivity (47.3%) and Thyro-mental distance was most specific (96%). The ULBT (upper lip bite tests) had most positive and negative predictive value (37.9% & 93. 5%).Data also showed that power of these tests in predicting easy intubation is more than their ability in assessing the likelihood of difficult intubation. There was no significant difference regarding difficult intubation based on gender (P < 0.05), whereas there were significant differences between the older tests and laryngeal view (P < 0.05, Mc-Nemar test). Despite the validity of MMP, TMD, ULBT and IIG in predicting easy intubation is much greater than the value in prediction of difficult intubation; however, the simplicity of performing these tests and results of the four tests in evaluating patients before surgery by combination of tests in predicting difficult intubation will likely safe. It seems that best results are from applying combined test than a single one.

scholarly journals ACCURACY OF THE UPPER LIP BITE TEST;

2012 ◽  
Vol 20 (01) ◽  
pp. 132-138
Author(s):  
MUHAMMAD ATIF ◽  
MUHAMMAD ABDULLAH ◽  
MUHAMMAD JAVAD YOUSAF ◽  
Khalid Buland
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

scholarly journals Comparison of Upper Lip Bite Test with Modified Mallampati Test and Thyromental Distance for Prediction of Difficult Intubation

2020 ◽  
Vol 5 (1) ◽  
pp. 2-9
Author(s):  
Sabin Koirala ◽  
Bigen Man Shakya ◽  
Moda Nath Marhatta
Keyword(s):  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Upper Lip ◽  
Cross Sectional ◽  
Airway Assessment ◽  
Total Percentage ◽  
Bedside Test ◽  
Sensitivity Specificity

Introduction: The prediction of difficult intubation using simple bedside test is of great importance to prevent mismanagement of airway. This study was conducted to compare Upper Lip Bite Test (ULBT) with Modified Mallampati Test (MMT) and Thyromental Distance (TMD) for the prediction of difficult intubation. Method: This was descriptive cross-sectional study conducted in 121 patients of  American Society of Anaesthesiologists Physical Status (ASA PS) I and II patients scheduled for elective surgery requiring general anaesthesia with endotracheal tube. The airway assessment of the patients was done one day prior to the surgery using Upper Lip Bite Test (ULBT), Modified Mallampati Test (MMT) and measurement of Thyromental Distance (TMD) . On the day of surgery during laryngoscopy, Cormack-Lehane (CL) grading was recorded. The CL grading of III and IV was labeled as difficult intubation. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR) of ULBT, MMT and TMD were calculated and compared. Results: The total percentage of difficult intubation, defined by Cormack-Lehane (CL) III and IV was 16.52 %. The sensitivity, specificity, PPV, NPV and accuracy of Upper Lip Bite Test (ULBT) was 50%, 100%, 100%, 91% and 91.74% respectively. ULBT had a significantly higher sensitivity, specificity and PPV when compared to MMT or  TMD or MMT and TMD when combined together. Conclusions:  Upper Lip Bite Test (ULBT) is better   predictor of difficult intubation  and it should be used along with other test during airway assessment.

scholarly journals COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

2021 ◽  
Vol 18 (5) ◽  
pp. 2650
Author(s):  
Giuseppe Vetrugno ◽  
Daniele Ignazio La Milia ◽  
Floriana D’Ambrosio ◽  
Marcello Di Pumpo ◽  
Roberta Pastorino ◽  
...  
Keyword(s):  
Blood Test ◽  
Healthcare Workers ◽  
Point Of Care ◽  
Venous Blood ◽  
Administrative Staff ◽  
Serological Tests ◽  
Predictive Values ◽  
Work From Home ◽  
Significant Difference ◽  
Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

scholarly journals Accuracy of the fluorescence-aided identification technique (FIT) for detecting tooth-colored restorations utilizing different fluorescence-inducing devices: an ex vivo comparative study

2021 ◽  
Author(s):  
W. Leontiev ◽  
E. Magni ◽  
C. Dettwiler ◽  
C. Meller ◽  
R. Weiger ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ex Vivo ◽  
Predictive Values ◽  
Composite Restorations ◽  
Significant Difference ◽  
Identification Technique ◽  
Illumination Method ◽  
Sensitivity Specificity ◽  
Entire Procedure ◽  
Higher Sensitivity

Abstract Objectives The aim of the present study was to compare the accuracy of the conventional illumination method (CONV) and the fluorescence-aided identification technique (FIT) for distinguishing between composite restorations and intact teeth using different fluorescence-inducing devices commonly used for FIT. Materials and methods Six groups of six dentists equipped with one of six different FIT systems each independently attempted to identify composite restorations and intact teeth on a full-mouth model with 22 composite restorations using CONV and, 1 h later, FIT. The entire procedure was repeated 1 week later. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, including 95% confidence intervals (CI), were calculated for CONV and FIT overall and for each device. The influence of examiner age, method, and device on each parameter was assessed by multivariate analysis of variance. Results The sensitivity (84%, CI 81–86%), specificity (94%, CI 93–96%), PPV (92%, CI 90–94%), and NPV (90%, CI 88–91%) of FIT was significantly higher than that of CONV (47%, CI 44–50%; 82%, CI 79–84%; 66%, CI 62–69%, and 69%, CI 68–71%, respectively; p<0.001). The differences between CONV and FIT were significant for all parameters and FIT systems except VistaCam, which achieved no significant difference in specificity. Examiners younger than 40 years attained significantly higher sensitivity and negative predictive values than older examiners. Conclusions FIT is more reliable for detecting composite restorations than the conventional illumination method. Clinical relevance FIT can be considered an additional or alternative tool for improving the detection of composite restorations.

scholarly journals Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

Medicina ◽  
2019 ◽  
Vol 55 (12) ◽  
pp. 760
Author(s):  
Aikaterini Amaniti ◽  
Panagiota Papakonstantinou ◽  
Dimitrios Gkinas ◽  
Ioannis Dalakakis ◽  
Evangelia Papapostolou ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Difficult Intubation ◽  
Elective Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cross Sectional Study ◽  
Laryngoscopic View ◽  
Cross Sectional ◽  
Intubation Difficulty ◽  
Difficulty Scale

Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors.

scholarly journals Evaluation of WHO criteria to determine degree of dehydration in children with acute diarrhea

2016 ◽  
Vol 45 (2) ◽  
pp. 76
Author(s):  
Suprawita Sari ◽  
Supriatmo Supriatmo ◽  
S L Margaretha ◽  
S Nafianti ◽  
B Hasibuan ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Clinical Signs ◽  
Severe Dehydration ◽  
Chi Square ◽  
Predictive Values ◽  
Who Criteria ◽  
Significant Difference ◽  
Kappa Value ◽  
The Difference ◽  
Sensitivity Specificity

Objective To evaluate the diagnostic accuracy and agreementbetween the 1980 and 1990 WHO criteria for determining the de-gree of dehydration in children with acute diarrhea.Methods This prospective study was conducted in two hospitalsfrom October 2002 to February 2003. Clinical signs of dehydrationall patients were recorded. The degree of dehydration based onthe 1980 and 1990 WHO criteria was determined and comparedwith fluid deficit measured by the difference of body weight on ad-mission and on discharge. Chi-square test and kappa value analy-ses were performed. Sensitivity, specificity, predictive values, andaccuracy of each WHO criteria were assessed. The prevalence ofdehydration was also determined.Results Sixty-five patients, comprising 40 boys and 25 girls, werestudied. There was a significant difference between the two WHOcriteria in differentiating between dehydration and non-dehydra-tion (P<0.05). Based on the 1980 WHO criteria the prevalence ofdehydration was 62.2%. Its sensitivity, specificity, and accuracy indiagnosing dehydration were 100.0%, 55.5%, and 86.2%, respec-tively. Based on the 1990 WHO criteria, the prevalence of dehy-dration was 60.0%. Its sensitivity, specificity, and accuracy in diag-nosing dehydration were 94.9%, 46.1%, and 75.4%, respectively.There was also a significant difference between both criteria indetermining severe dehydration (P<0.05). Based on the 1980 cri-teria, the prevalence of severe dehydration was 15.4%. Its sensi-tivity, specificity, and accuracy in diagnosing severe dehydrationwere 30.0%, 94.5%, and 84.6%, respectively. Based on the 1990criteria, these results were 40.0%, 94.5%, and 86.2%, respectively.The prevalence was 15.4%. Kappa value comparing the two WHOcriteria was 0.852 in diagnosing dehydration and 0.915 in diag-nosing severe dehydration. There was no significant differencebetween the two criteria in their sensitivity and specificity (P>0.05).Conclusion Both WHO criteria can be applied to determine de-hydration in patients with acute diarrhea, although we feel that the1990 criteria is simpler

scholarly journals PROKALSITONIN SEBAGAI PENANDA PEMBEDA INFEKSI BAKTERI DAN NON BAKTERI

2018 ◽  
Vol 17 (2) ◽  
pp. 76
Author(s):  
Bastiana Bastiana ◽  
Aryati Aryati ◽  
Dominicus Husada ◽  
M.Y. Probohoesodo
Keyword(s):  
Bacterial Infection ◽  
Roc Analysis ◽  
Final Diagnosis ◽  
Receiver Operating Curve ◽  
Fluorescent Assay ◽  
Infection Group ◽  
Cross Sectional ◽  
Predictive Values ◽  
Significant Difference ◽  
Sensitivity Specificity

Early diagnosis of an infection and prompt administration of an antibiotic can dramatically reduce morbidity and mortality.Procalcitonin (PCT), a precursor of calcitonin, has been proposed as a marker of bacterial infection. The aim of this study is to assess theefficiency of procalcitonin in children for the diagnosis of bacterial vs. non bacterial infection. This was a prospective, cross-sectional study.The subjects were enrolled consecutively, consisting of feverish children (temperature ³38.5° C) admitted to the Pediatric EmergencyDepartment with ages up to 12 years old. The subjects were divided into two groups according to their final diagnosis, bacterial and nonbacterial infection. Serum PCT concentration was measured by enzyme linked fluorescent assay (ELFA) method. Sensitivity, specificity,positive predictive and negative predictive values, and receiver operating curve (ROC) of PCT were calculated. Out of 54 patients,24 (44.4%) had a final diagnosis of bacterial infection. PCT showed a wide concentration range in the bacterial infection group (median:1.09 ng/mL, lower (L)=0.05 ng/mL, upper (U)=128.7 ng/mL) compared with non bacterial infection group (0.21 ng/mL; L=0.05ng/mL; U=12.15 ng/mL). There was a significant difference in PCT between the 2 groups (p=0.020). ROC analysis demonstrated anarea under curve (AUC) of 0.686 (95% CI, 0.534 to 0.838). Using a cut-off point of 0.5 ng/mL, the sensitivity, and specificity, positivepredictive and negative predictive values of PCT were 66.7%, 76.7%, 69.6%, 74.2%, respectively. In this study, PCT may be useful fordifferentiation of bacterial vs. non bacterial infection in children.

scholarly journals A simple estimation of glomerular filtration rate in children

2002 ◽  
Vol 42 (5) ◽  
pp. 193
Author(s):  
Syarifuddin Rauf ◽  
Husein Akbar
Keyword(s):  
Glomerular Filtration Rate ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Inexpensive Method ◽  
Predictive Values ◽  
Significant Difference ◽  
Simple Estimation ◽  
Nutritional Status Of Children ◽  
Sensitivity Specificity

Background The estimation of glomerular filtration rate (GFR) is routinely used in the assessment of renal function in children. An accurate measurement of GFR is very helpful in detecting renal disease.Objective The aim of this study was to compare GFR calculated by Schwartz's formula and that assessed by creatinine clearance measurement.Methods A study to evaluate GFR calculated by the Schwartz's fonnula and by the conventional creatinine clearance method was done on 114 (57%) boys and 86 (43%) girls aged 6-13 years hospitalized in the Department of Child Health, Hasanuddin University, Wahidin Sudirohusodo Hospital, Makassar in 1996.Results This study showed that there was no significant difference between the value of GFR determined by the conventional creatinine clearance method and that calculated by the Schwartz's fonnula according to age and sex. Our findings also did not show any  difference of GFR assessed by both methods according to nutritional status of children. In regard to the accuracy of Schwartz's fonnula, the sensitivity, specificity, positive, and negative predictive values were 87.5%, 98.86%, 9 1.3%, and 98.3%, respectively.Conclusion It seems that Schwartz's fonnula might be used for assessing GFR in children particularly if either there is no facility for measuring creatininuria or there is difficulty in collecting complete and accurate-timing urine samples. The formula is a very simple and inexpensive method for determining GFR in children compared to the conventional creatinine clearance method. 

scholarly journals Comparison of modified mallampati test between sitting and supine positions for prediction of difficult intubation

1970 ◽  
Vol 10 (1) ◽  
pp. 12-15 ◽  
Author(s):  
S Khatiwada ◽  
B Bhattarai ◽  
K Pokharel ◽  
R Acharya ◽  
A Ghirnire ◽  
...  
Keyword(s):  
Difficult Intubation ◽  
Supine Position ◽  
Difficult Laryngoscopy ◽  
Sitting Position ◽  
Predictive Values ◽  
Statistical Measures ◽  
Position Specificity ◽  
Grading Scale ◽  
Sensitivity Specificity ◽  
Grade Iii

Background: Modified Mallampati test is a standard method of assessing the airway for predicting potentially difficult laryngoscopy and intubation. This test requires the patient to be in sitting position for airway evaluation. Although applicable to the majority of patients, airway evaluation in sitting position may not always be convenient or advisable. Objectives: To compare modified Mallampati grades between sitting and supine position and to find out their corelation to Cormack and Lehane laryngoscopy grade. Materials: This prospective study was conducted in 215, ASA I and II patients undergoing various routine surgical procedures under general anaesthesia, in BPKIHS, Dharan over a period of 3 months. The airway assessment was done using modified Mallampati grade in sitting and supine positions. Mallampati grade of III or IV was defined as the predictor of difficult airway. The laryngoscopy grade was assessed using the Cormack and Lehane grading scale. Grade III or IV of Cormack and Lehane grades was defined as the difficult laryngoscopy and assumed as the predictor of difficult intubation. Statistical measures including sensitivity, specificity, positive and negative predictive values and accuracy were used for comparing the two positions for predicting difficult or ease of intubation. Results: Out of 215 patients, majority 146(68%) were females. Mallampati grade III or IV was observed in more patients in supine position compared to sitting position (48.3% vs. 35.8%, p = 0.008). Difficult laryngoscopy was observed in 13(6%) patients. Sensitivity of modified Mallampati test was 77% in both the positions. Predictive value of Mallampati grading for difficult intubation were 13% and 10% and for easy intubation were 96% and 97% respectively in sitting and supine position. Specificity and accuracy of modified Mallampati test were both 67% in sitting position, where as they were 54% and 55% respectively in supine position. Conclusion: Modified Mallampati grade significantly worsens in supine position compared to sitting. However, airway evaluation in both the positions almost equally predicts for difficult intubation. DOI: http://dx.doi.org/10.3126/hren.v10i1.6000 HREN 2012; 10(1): 12-15

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