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A Comparison of the Mallampati evaluation in neutral or extended cervical spine positions: a retrospective observational study of >80 000 patients
- Source :
- British Journal of Anaesthesia. 116:690-698
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Background The Mallampati examination is a standard component of an airway risk assessment. Existing evidence suggests that cervical spine extension improves the predictive power of the Mallampati examination for detecting difficult laryngoscopy and tracheal intubation, but a comparative effectiveness study has not been conducted. Methods The extended Mallampati examination (EMS) was introduced to the standard preoperative airway assessment, in addition to the standard Modified Mallampati examination (MMP). This study compared the accuracy of both Mallampati examinations on the prediction of difficult laryngoscopy, tracheal intubation, and bag mask ventilation. Univariate and adjusted analyses were performed. Results 80 801 patients with recorded MMP and EMS, and subsequent glottic view obtained during direct laryngoscopy, were examined. There was increased specificity (88.7% cf. 81.9%) but reduced sensitivity (33.3% cf. 45.7%) in the detection of difficult direct laryngoscopy with use of the EMS. The area under the receiver operating characteristic curve of each test performed in combination with other airway predictors for the models predicting difficult laryngoscopy was 0.740 (95% CI 0.731–0.753) for MMP and 0.739 (95% CI 0.729–0.752) for EMS. The area under the receiver operating characteristic curve of each test, performed in combination with other airway predictors for the models predicting difficult intubation was 0.699 (95% CI 0.688–0.711) for MMP and 0.695 (95% CI 0.683–0.707) for EMS. Conclusions This retrospective observational study demonstrates that cervical extension improves the specificity but decreases sensitivity of Mallampati examination. The Mallampati evaluation should be performed with the cervical spine in the neutral position to maximize test sensitivity.
- Subjects :
- Adult
Male
medicine.medical_treatment
Laryngoscopy
Physical examination
Anesthesia, General
Risk Assessment
Preoperative care
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
030202 anesthesiology
Preoperative Care
Intubation, Intratracheal
medicine
Humans
Physical Examination
Aged
Retrospective Studies
Aged, 80 and over
medicine.diagnostic_test
Receiver operating characteristic
business.industry
Tracheal intubation
Retrospective cohort study
Middle Aged
Respiration, Artificial
Anesthesiology and Pain Medicine
ROC Curve
Anesthesia
Cervical Vertebrae
Female
Airway
business
030217 neurology & neurosurgery
Mallampati score
Subjects
Details
- ISSN :
- 00070912
- Volume :
- 116
- Database :
- OpenAIRE
- Journal :
- British Journal of Anaesthesia
- Accession number :
- edsair.doi.dedup.....253235a127665292ed6bd2285d8d3f71
- Full Text :
- https://doi.org/10.1093/bja/aew056