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Validation of the GILLS score for tongue-lip adhesion in Robin sequence patients
Shelly Abramowicz1, Janine D Bacic, John B Mulliken
1Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts 02115, USA. shelly.abramowicz@childrens.harvard.edu
Insights
The GILLS score effectively predicts successful tongue-lip adhesion (TLA) for infants with Robin sequence. A low GILLS score (≤ 2) indicates TLA is the preferred airway management, while higher scores suggest alternative approaches.
Area of Science:
- Pediatric Surgery
- Neonatology
- Otolaryngology
Background:
- Robin sequence presents airway compromise challenges in infants.
- The GILLS score (Gastroesophageal reflux disease, preoperative intubation, late surgical intervention, low birth weight, syndromic diagnosis) was developed to assess risk.
- The GILLS score's utility in predicting tongue-lip adhesion (TLA) success for Robin sequence requires validation.
Purpose of the Study:
- To evaluate the predictive accuracy of the GILLS score for TLA success in infants with Robin sequence.
- To determine if the GILLS score can guide treatment decisions for airway management in Robin sequence.
Main Methods:
- Prospective study of infants with Robin sequence undergoing TLA for airway compromise.
- Patients were assessed using the 5-factor GILLS score.
- A GILLS score of ≤ 2 was hypothesized to predict successful TLA.
Main Results:
- Twenty infants with Robin sequence met inclusion criteria.
- TLA successfully managed airway compromise in 18 (90%) patients.
- The GILLS score demonstrated 83% sensitivity and 50% specificity for predicting TLA success.
Conclusions:
- The GILLS score accurately predicts TLA outcomes in Robin sequence infants.
- Infants with a GILLS score ≤ 2 are ideal candidates for TLA.
- Higher GILLS scores (≥ 3) indicate a significantly increased risk of TLA failure, necessitating alternative airway management strategies.
Background:
The GILLS score consists of gastroesophageal reflux disease, preoperative intubation, late surgical intervention, low birth weight, and syndromic diagnosis. The purpose of this study was to test the validity of the GILLS score in predicting success of tongue-lip adhesion (TLA) in managing Robin sequence.
Materials And Methods:
Infants with Robin sequence were included in the study if they had a TLA for airway compromise subsequent to formulation of the GILLS scoring system, that is, they were not included in the original GILLS analysis. The patients were prospectively considered based on the presence of the 5 factors that constitute the GILLS score. A score of ≤ 2 predicts success of TLA.
Results:
Twenty patients met the inclusion criteria. Tongue-lip adhesion managed the compromised airway in 18 (90%) of 20 patients. Overall, the GILLS score had a sensitivity of 83%, specificity of 50%, positive predictive value of 94%, and negative predictive value of 25%.
Conclusions:
The GILLS score accurately predicts a successful outcome for TLA in infants with Robin sequence. For infants with a score of 2 or less, TLA is the procedure of choice. Infants with a GILLS score of 3 or greater were 5 times more likely to fail TLA than those with a score of 2 or less. In these patients, other methods of managing the airway should be considered.
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