scholarly journals Assessment of Airway Parameters for Predicting Difficult Laryngoscopy and Intubation in a Tertiary Center in Western Nepal

2020 ◽  
Vol 17 (4) ◽  
pp. 516-520
Author(s):  
Gajal Lakhe ◽  
Hari Poudel ◽  
Krishna Murari Adhikari
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Area Under Curve ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
Upper Lip ◽  
Tertiary Center ◽  
Lehane Grade

Background: The screening tests used for pre-operative evaluation of airway to predict difficult laryngoscopy and intubation have variable diagnostic accuracy. The unanticipated poor laryngeal view is gold standard for defining difficult intubation. We aimed to find out the prevalence of difficult laryngoscopy and intubation, which airway parameter better predicts difficult intubation and whether difficult laryngoscopy is associated with difficult intubation or not.Methods: This analytic cross sectional study was conducted in 665 ASA I/II adult patients, aged 18-65, without obvious airway pathology undergoing elective surgery under general anesthesia. The pre-operative screening tests included mouth opening, modified mallampatti, ratio of height to thyromental distance, sternomentaldistance and upper lip bite test. Cormack-Lehane grade III/ IV was defined as difficult laryngoscopy and potentially difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under curve at 95% confidence interval was calculated for all five screening tests. Results: The prevalence of difficult laryngoscopy and intubation was 6.6% (44 cases). The upper lip bite test because of its highest specificity, positive predictive value, negative predictive value, accuracy and area under curve (99.7%; 93.9%; 99.7%; 95.2%; 85.1% respectively) with moderate level of sensitivity (70.5%) was better predictor of difficult intubation than other tests. The difficult laryngoscopy was associated with difficult intubation (p=0.00).Conclusions: The prevalence of difficult laryngoscopy and intubation was 6.6%.The upper lip bite test was a better predictor of difficult intubation and there was a significant association of difficult laryngoscopy with difficult intubation.Keywords: Difficult laryngoscopy and intubation; screening tests; upper lip bite test.

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 Evaluation of the risk of malignancy index in preoperative diagnosis of ovarian masses

2018 ◽  
Vol 7 (10) ◽  
pp. 4202
Author(s):  
Royyuru Suchitra ◽  
Kaustubh Burde ◽  
Nilima G. ◽  
P. L. S. Sahithi
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Low Cost ◽  
Age Groups ◽  
Screening Tests ◽  
Anatomical Location ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Grass Root Level

Background: Ovarian cancer possesses a challenge to screening tests due to its anatomical location, poor natural history, lack of specific lesion, symptoms and signs and low prevalence. Authors shall be considering RMI 2 and RMI 4 (forms of RMI) and comparing them with histopathology report to derive the sensitivity, specificity and other parameters of these tests.Methods: A prospective   study was conducted from September 2016- September 2017 at Mazumdar Shaw Hospital, Narayana Hrudayalaya, Bangalore.73 patients met the inclusion criteria. RMI 2   and RMI4 were calculated for all the patients and these scores were compared to the final histopathology reports.Results: In present study of 73 patients RMI2 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 81.25% and negative predictive value of 90.24 %. Whereas RMI4 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 83.87 and negative predictive value of 90.48 %. These results are comparable to other studies conducted.  The risk of malignancy index 2 and 4 are also almost comparable with each other and so either can be used for determining the risk of malignancy in patients with adnexal masses. These results were derived in an Indian population across all age groups showing that authors can apply this low-cost method even in resource limited settings.Conclusions: Authors found that Risk of malignancy index is a simple and affordable method to determine the likelihood of a patient having adnexal mass to be malignant. This can thus help save the resources and make the services available at grass root level.

scholarly journals Neutrophil Gelatinase Associated Lipocalin Urin sebagai Deteksi Dini Acute Kidney Injury

Sari Pediatri ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. 195
Author(s):  
Siti Aizah Lawang ◽  
Antonius Pudjiadi ◽  
Abdul Latief
Keyword(s):  
Acute Kidney Injury ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Area Under Curve ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Consecutive Sampling ◽  
Neutrophil Gelatinase

Latar belakang. Penelitian terkini fokus pada identifikasi biomarker yang lebih dini untuk acute kidney injury (AKI). Salah satunya adalah neutrophil gelatinase associated lipocalin (NGAL), protein 25 kDa yang merupakan potensial biomarker dini untuk AKI.Tujuan. Melihat neutrophil gelatinase associated lipocalin (NGAL) sebagai biomarker dini untuk acute kidney injury (AKI).Metode. Penelitian kualitatif dengan desain uji diagnostik. Pengambilan sampel secara cross sectional dan consecutive sampling pada 50 orang anak, terdiri atas 28 sepsis dan 22 sepsis berat di ruang rawat intensif anak di RS. Cipto Mangunkusomo Jakarta dan RS. Wahidin Sudirohusodo Makassar.Hasil. Terdapat perbedaan sangat bermakna kadar NGAL urin dan kreatinin berdasarkan beratnya sepsis (p<0,001). Nilai rerata sepsis 132,93 ng/mL dan sepsis berat 2159,98 ng/mL. Terdapat perbedaan bermakna antara beratnya AKI menurut kriteria RIFFLE dengan beratnya sepsis (p=0,013). Tidak terdapat hubungan bermakna antara kadar NGAL urin dengan kriteria RIFFLE (p=0,173). Nilai sensitifitas NGAL urin 100% dan spesifisitas 63,63%, positive predictive value 27,27%, negative predictive value 100% dan area under curve (AuOC) 0,826.Kesimpulan. Neutrophil gelatinase associated lipocalin (NGAL) dapat dipakai sebagai skrining AKI.

Ratio of height to thyromental distance: a comparison with Mallampati and Upper lip Bite test for predicting difficult intubation in Pakistani population

2021 ◽  
pp. 1-15
Author(s):  
Saman Tauheed Ali ◽  
Khalid Samad ◽  
Syed Amir Raza ◽  
Muhammad Qamarul Hoda
Keyword(s):  
Predictive Value ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
Difficult Laryngoscopy ◽  
University Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Elective Surgical Procedures ◽  
Lehane Grade ◽  
Sensitivity Specificity

Objectives: We conducted this study to compare the accuracy of three diagnostic tests; ratio of height to thyromental distance (RHTMD), Modified Mallampati Test (MMT) and Upper Lip Bite Test (ULBT) in predicting difficult laryngoscopy using Cormack and Lehane grade as gold standard.Methods: This study was conducted in Aga Khan University Hospital, Karachi. Based on calculated sample size, 383 patients who required endotracheal intubation for elective surgical procedures were enrolled with consecutive sampling techniques during August 2014 to August 2015 for this cross-sectional study. Primary investigator used RHTMD, ULBT, and MMT for assessing the airway and correlated with laryngoscopic view.Results: A total of 383 patients were incorporated in this research, out of which 59(15.4%) classified as difficult laryngoscopy based on Cormack and Lehane (CL) grading. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of RHTMD (84.7%, 90.1%, 60.9%, 97%, 89.3%) and ULBT (83.1%, 89.2%, 58.3%, 96.7%, 88.3%) values were highest as compared to MMT (30.5%, 84.3%, 26.1%, 86.9%, 79.9%). The area under a receiver-operating characteristic curve (AUC of ROC curve) for ULBT and RHTMD was significantly more than for MMT (P<0.01). RHTMD and ULBT both are acceptable alternatives for prediction of difficult laryngoscopy as a simple, single bed-side test. Continuous...

scholarly journals Prediction of Difficult Airway Among Patients Requiring Endotracheal Intubation in a Tertiary Care Hospital in Eastern Nepal

2017 ◽  
Vol 56 (207) ◽  
pp. 314-318 ◽  
Author(s):  
Sindhu Khatiwada ◽  
Balkrishna Bhattarai ◽  
Krishna Pokharel ◽  
Roshan Acharya
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Tertiary Care ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
Care Hospital ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Lehane Grade

Introduction: Unanticipated difficult intubation is an undesirable situation. Various bedside screening tests are routinely performed for predicting difficult airway. Although considered a surrogate indicator, difficult laryngoscopy is not the exact measure of intubation difficulty. We aimed to determine the best screening test for predicting difficult laryngoscopy and the association between difficult laryngoscopic view and difficult intubation. Methods: This prospective, observational study involved 314, ASA I/II adult patients requiring endotracheal intubation for various routine surgical procedures. Sternomental distance < 12 cm, thyromental distance < 6.5cm, inter-incisor distance < 3.5 cm, mandibular protrusion grade 3 and modified Mallampati class III/IV were the predictors of difficult laryngoscopy. Laryngoscopic view was defined as ‘difficult’ when the Cormack and Lehane grade was III/ IV. The sensitivity, specificity, positive and negative predictive values and accuracy of these predictors were compared to find out the best predictor. Requirement of >3 attempts for insertion of the tracheal tube was defined as ‘difficult intubation’. The association between difficult laryngoscopic view and difficult intubation was determined. Results: The sensitivity of the modified Mallampati class for predicting difficult laryngoscopy was highest (83%). Twelve (3.8%) patients had grade III laryngoscopic view and none had a grade of IV. Intubation was difficult in seven (2.2%) patients. Majority of patients (4 of 7) with difficult intubation had difficult laryngoscopic view (p<0.001). Conclusions: Modified Mallampati test was better for predicting difficult laryngoscopy compared to other bedside screeing tests. Difficult laryngoscopy could significantly predict difficult intubation in our patients.   Keywords: Airway evaluation; difficult intubation; difficult laryngoscopy; modified Mallampati class; Nepalese patients; sensitivity.

A COMPARATIVE STUDY OF MODIFIED MALLAMPATI CLASSIFICATION WITH NECK CIRCUMFERENCE ALONG WITH UPPER LIP BITE TEST IN MORBIDLY OBESE PATIENTS

2021 ◽  
pp. 22-24
Author(s):  
Swati Sharma ◽  
Rajbhan Singh
Keyword(s):  
Predictive Value ◽  
Pearson Correlation ◽  
Neck Circumference ◽  
Screening Tests ◽  
Morbidly Obese ◽  
Laparoscopic Bariatric Surgery ◽  
Obese Patients ◽  
Upper Lip ◽  
Lehane Grade ◽  
Grade Iii

INTRODUCTION: Anaesthesia in morbidly obese patients can present many challenges. The overriding concern of most anaesthesiologists is airway management, as obese patients have been thought to be at greater risk of difcult airway and/or difcult intubation, when compared with the general population. The term 'difcult airway' has been dened by the American Society of Anaesthesiologists (ASA) taskforce as the clinical situation in which a conventionally trained anaesthesiologist experiences problems with mask ventilation or tracheal intubation or both. AIMS AND OBJECTIVES- To assess the positive predictive value,sensitivity and specicity of MMPC, NC along with ULBT and compare it with Cormack Lehane grading intraoperatively. MATERIALS AND METHOD- Preoperative airway assessment of 200 patients posted for surgery under general anaesthesia was carried out to evaluate the usefulness of multiple screening tests in predicting the ease or difculty of laryngoscopy in obese patients undergoing laparoscopic bariatric surgery. Modied Mallampati test grade III or IV, Upper Lip Bite test grade III, Neck Circumference >40cm were considered as predictors of difcult laryngoscopy. Laryngoscopy was considered difcult if the view on laryngoscopy was Cormack and Lehane grade III or IV. The results were evaluated on the basis of sensitivity, specicity, positive and negative predictive value and accuracy of these tests. RESULT- Group A (ULBT+MMPC) identied 65% of the patients with difcult intubation (sensitivity of 92.86 % & specicity of 33.3 %), whereas Group B (ULBT+NC) identied 75% of the patients with difcult airway (sensitivity 93.75% & specicity of 25%). Pearson Correlation analysis was applied to know the correlation between the various tests and the Cormack Lehane Classication, both the groups had p value of 0.001 , which was highly signicant. CONCLUSION-When multiple predictors are taken into consideration there was a considerable reduction in false negatives with signicant improvement in accuracy of test and hence prediction of difcult laryngoscopy was made easy. Application of multiple predictors in combination can reduce the frequency of unanticipated difculty and unnecessary interventions related to over prediction of airway difculty.

scholarly journals Screening Tests for Predicting Difficult Intubation. A Clinical Assessment in Turkish Patients

1998 ◽  
Vol 26 (4) ◽  
pp. 382-386 ◽  
Author(s):  
H. Bilgin ◽  
G. Özyurt
Keyword(s):  
Positive Predictive Value ◽  
Difficult Intubation ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Screening Tests ◽  
Sensitive Test ◽  
Predictive Values ◽  
Significant Difference ◽  
Turkish Patients

Three methods of predicting difficult intubation were compared prospectively. Mallampati test, Wilson risk-sum and thyromental distance were determined preoperatively and laryngeal views were graded in 500 patients. The sensitivities, specificities, positive and negative predictive values of each test were calculated. The incidence of difficult intubation was found to be 8%. The sensitivities of the Mallampati test, the Wilson risk-sum and the thyromental distance were 43%, 58% and 35% respectively, and the specificities were 93%, 91% and 95% respectively. Significant differences were seen between the sensitivities of the Mallampati test and the Wilson risk-sum (P<0.001), the Wilson risk-sum and the thyromental distance (P<0.001), the Mallampati test and the thyromental distance (P<0.05). Among the different specificities, the only significant difference was observed between the Wilson risk-sum and the thyromental distance (P<0.05). There were no significant differences between the positive and negative predictive values of the three screening tests (P>0.05). In conclusion, the Wilson risk-sum was the most sensitive test and the thyromental distance has the highest positive predictive value for difficult intubation.

scholarly journals The Evaluation of Thyromental Height Test as a Single, Accurate Predictor of Difficult Laryngoscopy

2020 ◽  
Vol 18 (2) ◽  
pp. 271-276
Author(s):  
Prabhat Rawal ◽  
Surendra Man Shrestha
Keyword(s):  
Positive Predictive Value ◽  
General Anesthesia ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Difficult Laryngoscopy ◽  
Clinical Test ◽  
Distance Measurements ◽  
Easy Method ◽  
Cross Sectional ◽  
Accurate Predictor

Background: Thyromental Height Test is a relatively new, easy method considered as a more accurate predictor of difficult laryngoscopy than existing methods. The aim of this study was to evaluate its accuracy in predicting difficult laryngoscopy as compared to commonly used methods.Methods: This hospital based, cross-sectional, observational study was conducted on 246 patients scheduled for surgery under general anesthesia with endotracheal intubation. Airway assessment was done during pre-anesthetic assessment by Thyromental Height Test, Modified Mallampati Test, Thyromental Distance and Sternomental Distance measurements and predicted as ‘difficult’ or ‘easy’ laryngoscopy based on accepted cut-off values. Direct laryngoscopic view was assessed after administration of general anesthesia by a laryngoscopist unaware of the pre-anesthetic assessments and recorded as ‘actual’ difficult or easy laryngoscopy based on Cormack-Lehane grades. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each clinical test were determined. Results: Thyromental Height Test had the highest sensitivity (71.42%) and negative predictive value (98.9% respectively) but lowest accuracy (77.2%). Maximum specificity was observed with Thyromental Distance and Sternomental Distance (97.49% each). Thyromental Distance had the highest positive predictive value (25%) and accuracy (95.52%). Conclusions: Thyromental Height Test, with its high sensitivity, is a useful predictor of difficult laryngoscopy. However, due a high number of false positives and relatively low accuracy, it cannot be considered as a sole, reliable and accurate predictor of difficult laryngoscopy. Keywords: Accuracy; difficult laryngoscopy; predictor; thyromental height

scholarly journals Evaluation of sensitivity and spesitivity as COVID–19 screening method

2021 ◽  
Vol 10 (4) ◽  
pp. 758
Author(s):  
Atikah Nurhesti ◽  
Solikhah Solikhah ◽  
Siti Nur Djannah
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Close Contact ◽  
Screening Method ◽  
Rapid Test ◽  
Antibody Test ◽  
Screening Tests ◽  
Rapid Antibody

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Antibody rapid test is one of the COVID-19 screening tests that can be used in the community. The accuracy of the rapid antibody methods needs to be appropriately assessed, it is necessary to carry out a diagnostic accuracy study using a pairwise sensitivity and specificity analysis. This research aimed to assess the sensitivity and specificity of COVID-19 rapid tests, also assesses positive predictive value (PPV) and negative predictive value (NPV) of the rapid antibody test as a method of screening for COVID-19 in Sleman Regency, Indonesia. In total, 118 respondents who have contact with COVID-19 patients and have symptoms were enrolled in this study. The study was conducted on 118 patients who had been in contact with confirmed COVID-19 118 patients who met the close contact criteria were conducted a rapid antibody test. 64.41% patients were reactive. Real-time polymerase chain reaction (RT PCR) as a gold standard was also carried out for all patients and 63.56% affirmed positive for COVID-19. The sensitivity value was 97.33%, and the specificity value was 93.02%, while the positive predictive value (NPP) was 96.05%, and the negative predictive value (NPN) was 95.24%. These results meet the minimum recommendations for the screening method.

Diagnostic Value of Pap Smear and Colposcopy in Non-benign Cervical Lesions

2018 ◽  
Vol 7 (2) ◽  
pp. 211-215
Author(s):  
Manizheh Sayyah-Melli ◽  
Vahideh Rahmani ◽  
Elaheh Ouladsahebmadarek ◽  
Mehri Jafari-Shobeiri ◽  
Parvin Mostafa Gharabaghi ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Pap Smear ◽  
Screening Tests ◽  
Specific Method ◽  
Diagnostic Utility ◽  
Cervical Lesions ◽  
Sensitivity Specificity

Objectives: Cervical cancer is a very common and lethal condition; however, owing to longstanding premalignant lesions, it is possible to prevent morbidity and mortality by screening tests. Pap smear, colposcopy, and biopsy are among the main modalities in this regard, however there is no consensus on the diagnostic utility of the first 2 methods. This study sought to examine the diagnostic utility of Pap smear, colposcopy, and cytology in evaluating the non-benign cervical lesions. Materials and Methods: A cross-sectional study was carried out between 2014 and 2016 in an out-patient setting at Alzahra teaching hospital of Tabriz University of Medical Sciences. After obtaining informed consent, all 315 participants with abnormal Pap test underwent colposcopy and biopsy from the abnormal areas. Cervical biopsy was considered as a gold standard and the diagnostic values of Pap smear and colposcopy were individually compared by calculating sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio. Results: The mean age of patients was 38.49±10.31 years (17-68 years). On the basis of biopsy findings, non-benign cervical lesions were present in 31 cases (9.8%). Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio of Pap smear in revealing non-benign cervical lesions were 77.4%, 69.7%, 21.8%, 95.6%, 70.7%, and 2.55%, and for colposcopy, were 90.3%, 90.9%, 51.9%, 98.9%, 90.8%, and 99.2%, respectively. Conclusions: Based on our results, the colposcopy is a sensitive and specific method in differentiating benign cervical lesions from non-benign cervical lesions. The accuracy of Pap smear is intermediate in this regard, and the utility is limited. Therefore, this method should not be considered as the main criterion for decision making.

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