Arne et al developed a score for predicting if a patient will experience difficulties during endotracheal intubation. The authors are from the University of Poitiers in France.
Patient selection: endotracheal intubation
Outcome: difficult intubation
Parameters:
(1) previous history of a difficult intubation
(2) pathologies present that are associated with a difficult intubation (malformations, acromegaly, cervical spondylosis, tumor of the airway, etc0
(3) clinical symptoms of airway pathology (dyspnea from airway pathology, dysphagia, sleep apnea, etc)
(4) inter-incisor gap (IIG) in cm at maximum mouth opening and mandibular luxation (ML)
(5) thyromental distance in cm
(6) maximum range of head and neck movement in degrees
(7) Mallampati's modified test
|
Parameter |
Finding |
Points for Exact Score |
Points for Simplified Score |
|
previous history |
no |
0 |
0 |
|
|
yes |
3.28 |
10 |
|
pathologies associated with difficulties |
no |
0 |
0 |
|
|
yes |
1.63 |
5 |
|
clinical symptoms |
no |
0 |
0 |
|
|
yes |
0.98 |
3 |
|
IIG and ML |
IIG >= 5 cm OR ML > 0 (positive) |
0 |
0 |
|
|
other |
1.09 |
3 |
|
|
IIG < 3.5 cm AND ML < 0 (negative) |
4.12 |
13 |
|
thyromental distance |
>= 6.5 cm |
0 |
0 |
|
|
< 6.5 cm |
1.36 |
4 |
|
maximum range |
> 100 degrees |
0 |
0 |
|
|
80 to 100 degrees |
0.65 |
2 |
|
|
< 80 degrees |
1.46 |
5 |
|
Mallampati |
Class I |
0 |
0 |
|
|
Class II |
0.66 |
2 |
|
|
Class III |
1.93 |
6 |
|
|
Class IV |
2.52 |
8 |
where:
• For IIG and ML the second category is given as ML =0 and IIG < 5 and > 3.5. As written there could be results not covered.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum scores: 0
• maximum exact score: 15.35
• maximum simplified score: 48
• A simplified score >= 11 was associated with difficult intubation.
Performance:
• The sensitivity for a cutoff of 11 was 90-94% and specificity 66-96%.
Specialty: Anesthesiology, Surgery, general, Pulmonology, Cardiology, Emergency Medicine, Otolaryngology
