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Reliability of the Cormack-Lehane Classification: A Scoping Review
Anoohya Arkala1, Maninder Kaur1, Joseph Rauscher2
1Department of Internal Medicine / Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA.
Cureus
|April 25, 2025
Summary
This review found limited evidence on the reliability of Cormack-Lehane and modified Cormack-Lehane classifications. Inter-rater reliability varied widely, indicating a need for standardized methods in airway assessment.
Area of Science:
- Anesthesiology
- Airway Management
- Medical Education
Background:
- The Cormack-Lehane and modified Cormack-Lehane classifications are widely used to describe glottic view during laryngoscopy.
- Estimating the reliability of these classifications is crucial for consistent airway management and patient safety.
Purpose of the Study:
- To conduct a scoping review to identify and describe studies estimating the inter-rater reliability of the Cormack-Lehane and modified Cormack-Lehane classifications.
- To analyze the kappa statistic (κ) values reported in the literature for these classifications.
Main Methods:
- A comprehensive scoping review was performed using PubMed, Google Scholar, and Google.com (gray literature) from October 2024 to January 2025.
- Studies reporting a kappa statistic (κ) for Cormack-Lehane grades between at least two raters were included, with no date or language restrictions.
- A total of 15 articles met the inclusion criteria after screening 825 PubMed records and 1,200 gray literature records.
Main Results:
- The review included studies using still images (n=6) and videos (n=8) from direct, video, or fiberoptic laryngoscopy in various settings (operating room, simulation, office, prehospital).
- Studies examined both the original Cormack-Lehane (n=10) and modified (n=6) classifications.
- Inter-rater reliability, measured by the kappa statistic (κ), ranged widely from 0.020 (slight agreement) to 0.888 (almost perfect agreement).
Conclusions:
- The evidence base for the reliability of the Cormack-Lehane and modified Cormack-Lehane classifications is limited.
- Heterogeneous methodologies and variable results highlight the need for further research with standardized approaches.
- Improved reliability in airway grading is essential for consistent clinical practice and patient safety.
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