Usefulness of difficult airway predictors in the emergency department

Pérez Santos FJ, Hernández Salgado M, Díaz-Landeira J, Santana Domínguez M, Domínguez García P, Herrera García M

Objective: To determine the usefulness of difficult airway predictors in the emergency

department and the prognostic value of some of these predictors.

Methods: A descriptive, observational study was carried out in the emergency

department over a period of 14 months. We studied patients who required intubation to

establish an airway, assessing the likelihood of difficult airway by Mallampati score,

Cormack-Lehane classification, and sternomental distance and calculating the predictive

value, sensitivity, and specificity of these variables by themselves and in combination.

Results: We identified 137 patients requiring orotracheal intubation, which was

successful in fewer than 3 attempts in 79.5% and in 5 minutes or less in 92.3%. In 98

patients we were able to assess the likelihood of difficult airway in advance. The positive

predictive value was 100% for the Mallampati score (sensitivity, 100%; specificity,

77.7%), 87.5% for the Cormack-Lehane classification (sensitivity, 98.8%; specificity,

100%), and 66.6% for the sternomental distance (sensitivity 85.7%; specificity, 96.0%).

No gender-related differences in the incidence of difficult airway were observed.

Conclusions: The Mallampati score had the best predictive value, sensitivity, and

specificity. The difficulty of an airway could usually be predicted.

Domínguez García P, Díaz-Landeira J, Hernández Salgado M, Herrera García M, Pérez Santos FJ, Santana Domínguez M