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Inter-observer reliability of ten tests used for predicting difficult tracheal intubation
K Karkouti1, D K Rose, L E Ferris
1Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
Summary
Preoperative airway assessment tests show variable reliability. Mouth opening and chin protrusion were highly reliable, while others like the Mallampati technique had poor reliability for predicting difficult tracheal intubation.
Area of Science:
- Anesthesiology
- Airway Management
- Medical Diagnostics
Background:
- Predicting difficult tracheal intubation is crucial for patient safety during surgery.
- Numerous preoperative airway assessment tests exist, but their reliability is often debated.
Purpose of the Study:
- To evaluate the inter-observer reliability of ten common preoperative airway assessment tests.
- To determine the consistency of these tests when performed by different experienced clinicians.
Main Methods:
- Prospective study of 59 patients undergoing elective surgery requiring tracheal intubation.
- Two independent, experienced observers performed ten airway assessment tests.
- Inter-observer reliability was quantified using Kappa (K) and intraclass correlation coefficient (ICC).
Main Results:
- Mouth opening (ICC = 0.93) and chin protrusion (ICC = 0.89) demonstrated excellent inter-observer reliability.
- Seven tests showed moderate reliability, including thyromental distance and atlanto-occipital measurements.
- The Mallampati technique for oropharyngeal view assessment had poor reliability (K = 0.31).
Conclusions:
- Many preoperative airway assessment tests exhibit only moderate inter-observer reliability.
- This variability may explain the inconsistent accuracy of these tests in predicting difficult tracheal intubation in prior research.