Is the 'LEMON' method an easily applied emergency airway assessment tool?

Objective: To assess whether the 'LEMON' method, devised by the developers of the US National Emergency Airway Management Course, is an easily applied airway assessment tool in patients undergoing treatment in the emergency department resuscitation room.
Methods: One hundred patients treated in the resuscitation room of a UK teaching hospital between June 2002 and January 2003 were assessed on criteria based on the 'LEMON' method.
Results: All seven criteria of the 'Look' section of the method could be adequately assessed. Data for the 'Evaluate' section could not be obtained in 10 patients, with inter-incisor distance being the most problematical item. The 'Mallampatti' score was unavailable in 43 patients, and had to be assessed in the supine position in 32 of the remaining 57 patients. Assessment for airway 'Obstruction' and 'Neck mobility' could be performed in all patients.
Conclusion: The 'Look', 'Obstruction' and 'Neck mobility' components of the 'LEMON' method are the easiest to assess in patients undergoing treatment in the emergency department resuscitation room. The 'Evaluate' and 'Mallampatti' components are less easily applied to the population that present to the resuscitation room, and assessment of these is more problematical and prone to inaccuracy. We suggest that the 'LEMON' airway assessment method may not be easily applied in its entirety to unselected resuscitation room patients, and that information on the 'Evaluate' and 'Mallampatti' parameters may not always be available.