Abstract
Purpose
To determine inter-observer reliability of ten preoperative airway assessment tests used for predicting difficult tracheal intubation.
Method
We prospectively assessed 59 patients undergoing elective surgery requiring tracheal intubation at a large metropolitan teaching hospital. Two experienced observers independently conducted the airway assessment tests on the same group of patients. Inter-observer reliability was examined using Kappa (K) and intraclass correlation coefficient (ICC).
Results
Two tests — mouth opening (ICC = 0.93) and chin protrusion (ICC = 0.89) — had excellent inter-observer reliability. Seven tests — thyromental distance (ICC =0.74), subluxation (K = 0.66), atlanto-occipital extension distance (ICC = 0.67) and angle (K = 0.66), profile classification (K = 0.58), ramus length (ICC = 0.53), oropharyngeal best view (K = 0.49) — were moderately reliable. One test — Mallampati technique of assessing oropharyngeal view (K = 0.31) — had poor reliability.
Conclusion
Many of the preoperative airway tests have only moderate inter-observer reliability. This may provide some insight into why previous research has failed to show that the tests accurately predict difficult trachéal intubation.
Résumé
Objectif
Comparer la fiabilité de dix tests préopératoires de dépistage de l’intubation difficile.
Méthode
Cinquante-neuf patients soumis à une chirurgie non urgente avec intubation ont été évalués de façon prospective dans un important hôpital métropolitan. Deux observateurs d’expérience ont examiné séparément les voies aériennes des patients d’un même groupe. La fiabilité de l’examen a été comparée avec les coefficients Kappa et de corrélation interclasse (ICC).
Résultats
Deux tests — l’ouverture de la bouche (ICC = 0,93) et la profusion du menton (ICC = 0,89) avaient une excellente fiabilité comparée. Sept tests — la distance thyromentionnière (ICC = 0,74), la subluxation (K = 0,66), l’extension (ICC = 0,67) et (K = 0,66) l’angle atlanto-occipitaux, la classification du profil (K = 0,58), la longueur de la branche montante (ICC = 0,53), la meilleure visibilité oropharyngée (K = 0,43) — étaient modérément fiables. Un test — la technique d’évaluation oropharyngée de Mallampati — était peu fiable (K = 0,31).
Conclusion
Plusieurs des tests préopératoires ne sont que modérément fiables. Ceci peut expliquer pourquoi les études réalisées antérieurement n ’ont pas réussi à démontrer que ces test pouvaient dépister l’intubation difficile.
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Karkouti, K., Rose, D.K., Ferris, L.E. et al. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth 43, 554–559 (1996). https://doi.org/10.1007/BF03011765
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DOI: https://doi.org/10.1007/BF03011765