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An Evaluation of the Efficacy of Predictive Tests and Anthropometric Measurements in Determining Difficult Intubation

Lütfiye Pirbudak1, Didem Yılmaz Doğan1, Ergün Mendeş2

  • 1Department of Anesthesiology and Reanimation, Gaziantep University, Research and Application Hospital, Gaziantep, Türkiye.

Journal of Clinical Practice and Research
|November 19, 2025
PubMed

Insights

Predictive tests and anthropometric measurements can identify difficult pediatric intubation. Specific thyromental distance (TMD) and sternomental distance (SMD) values are useful for predicting difficult intubation in younger children.

Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Airway Management

Background:

  • Pre-intubation risk assessment is vital for patient safety.
  • Identifying difficult intubation in pediatric patients is challenging.

Purpose of the Study:

  • To evaluate the effectiveness of predictive tests and anthropometric measurements in identifying potential difficult intubation in children.
  • To compare various prediction tests with the Cormack-Lehane classification.

Main Methods:

  • Prospective study of 200 pediatric patients (7-15 years) undergoing general anesthesia.
  • Assessed Modified Mallampati Classification (MMC), mandibular protrusion (MP), tooth anomalies, thyromental distance (TMD), sternomental distance (SMD), and atlanto-occipital joint mobility.
  • Compared test results with Cormack-Lehane (CL) classification.

Main Results:

  • Significant differences found in TMD, SMD, and missing teeth across age groups.
  • MMC showed highest sensitivity (100%) and positive predictive value (PPV) (47%).
  • MP demonstrated the highest specificity (94.5%).

Conclusions:

  • Reference values of ≤5 cm for TMD and ≤10 cm for SMD provide useful predictive information for children aged 7-9 years.
  • Age-specific reference values are crucial for accurate prediction of difficult intubation in pediatric populations.
Abstract

Keywords:
Cormack–Lehane classificationPediatricsanthropometrydifficult intubationgeneral anesthesiatracheal intubation

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