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Related Experiment Video

Updated: Dec 23, 2025

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
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Development of a scoring system for predicting difficult intubation using ultrasonography.

Harith Daggupati1, Indubala Maurya2, Roshan D Singh3

  • 1Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Pondicherry, India.

Indian Journal of Anaesthesia
|April 30, 2020
PubMed
Summary

A new airway scoring system incorporating ultrasound skin-to-epiglottis distance (SED) significantly improves difficult intubation prediction. This USED-MSH score offers higher accuracy than clinical predictors alone.

Keywords:
Airway ultrasounddifficult intubationskin-to-epiglottis distance

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Area of Science:

  • Anesthesiology
  • Medical Imaging
  • Predictive Diagnostics

Background:

  • Difficult intubation poses a significant risk during anesthesia.
  • Ultrasound measurement of skin-to-epiglottis distance (SED) shows promise in predicting difficult laryngoscopy.

Purpose of the Study:

  • To develop and assess an airway scoring system incorporating SED with existing clinical predictors.
  • To determine if the new system improves the accuracy of predicting difficult intubation.

Main Methods:

  • A cohort of 310 adult patients had mentohyde distance, mandibular subluxation, head extension, and SED measured preoperatively.
  • A novel USED-MSH score was created by combining SED with three clinical factors (MSH score).
  • Receiver-operating characteristic curves and AUC were used to compare the predictive performance of MSH and USED-MSH scores.

Main Results:

  • Difficult intubation occurred in 20% of patients.
  • The USED-MSH score demonstrated a significantly higher AUC (0.93) compared to the MSH score (0.76) for predicting difficult intubation.
  • USED-MSH showed improved sensitivity (93.6%) and similar positive predictive value compared to the MSH score.

Conclusions:

  • The USED-MSH airway scoring system, integrating ultrasound SED measurements, is a valuable tool for predicting difficult intubation.
  • This enhanced predictive accuracy can aid anesthesiologists in managing challenging airway cases.