Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds
Background: There is currently some discussion over the actual usefulness of performing preoperative upper airway assessment to predict difficult airways. In this field, modified Mallampati test (MMT) is a widespread tool used for prediction of difficult airways showing only a feeble predictive perf...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421003584 |
| _version_ | 1811231909369348096 |
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| author | Cl.ístenes C. de Carvalho Danielle M. da Silva Marina S. Leite Fl..via A. de Orange |
| author_facet | Cl.ístenes C. de Carvalho Danielle M. da Silva Marina S. Leite Fl..via A. de Orange |
| author_sort | Cl.ístenes C. de Carvalho |
| collection | DOAJ |
| description | Background: There is currently some discussion over the actual usefulness of performing preoperative upper airway assessment to predict difficult airways. In this field, modified Mallampati test (MMT) is a widespread tool used for prediction of difficult airways showing only a feeble predictive performance as a diagnostic test. We therefore aimed at evaluating if MMT test would perform better when used as a screening test rather than diagnostic. Methods: An accuracy prospective study was conducted with 570 patients undergoing general anesthesia for surgical procedures. We collected preoperatively data on sex, age, weight, height, body mass index (BMI), ASA physical status, and MMT. The main outcome was difficult laryngoscopy defined as Cormack and Lahane classes 3 or 4. Bivariate analyses were performed to build three different predictive models with their ROC curves. Results: Difficult laryngoscopy was reported in 36 patients (6.32%). Sex, ASA physical status, and MMT were associated with difficult laryngoscopy, while body mass index (BMI) was not. The MMT cut-off with the highest odds ratio was the class II, which also presented significantly higher sensitivity (94.44%). The balanced accuracy was 67.11% (95% CI: 62.78...71.44%) for the cut-off of class II and 71.68% (95% CI: 63.83...79.54) for the class III. Conclusion: MMT seems to be more clinically useful when the class II is employed as the threshold for possible difficult laryngoscopies. At this cut-off, MMT shows the considerable highest sensitivity plus the highest odds ratio, prioritizing thus the anticipation of difficult laryngoscopies. |
| first_indexed | 2024-04-12T10:52:58Z |
| format | Article |
| id | doaj.art-18f14286377846c5ac823420657de6f2 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T10:52:58Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-18f14286377846c5ac823420657de6f22022-12-22T03:36:10ZengElsevierBrazilian Journal of Anesthesiology0104-00142022-11-01726736741Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholdsCl.ístenes C. de Carvalho0Danielle M. da Silva1Marina S. Leite2Fl..via A. de Orange3Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Universidade Federal de Campina Grande, Campina Grande, PB, Brazil; Corresponding author.Hospital das Cl.ínicas de Pernambuco, Recife, PE, BrazilHospital das Cl.ínicas de Pernambuco, Recife, PE, BrazilInstituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Hospital das Cl.ínicas de Pernambuco, Recife, PE, BrazilBackground: There is currently some discussion over the actual usefulness of performing preoperative upper airway assessment to predict difficult airways. In this field, modified Mallampati test (MMT) is a widespread tool used for prediction of difficult airways showing only a feeble predictive performance as a diagnostic test. We therefore aimed at evaluating if MMT test would perform better when used as a screening test rather than diagnostic. Methods: An accuracy prospective study was conducted with 570 patients undergoing general anesthesia for surgical procedures. We collected preoperatively data on sex, age, weight, height, body mass index (BMI), ASA physical status, and MMT. The main outcome was difficult laryngoscopy defined as Cormack and Lahane classes 3 or 4. Bivariate analyses were performed to build three different predictive models with their ROC curves. Results: Difficult laryngoscopy was reported in 36 patients (6.32%). Sex, ASA physical status, and MMT were associated with difficult laryngoscopy, while body mass index (BMI) was not. The MMT cut-off with the highest odds ratio was the class II, which also presented significantly higher sensitivity (94.44%). The balanced accuracy was 67.11% (95% CI: 62.78...71.44%) for the cut-off of class II and 71.68% (95% CI: 63.83...79.54) for the class III. Conclusion: MMT seems to be more clinically useful when the class II is employed as the threshold for possible difficult laryngoscopies. At this cut-off, MMT shows the considerable highest sensitivity plus the highest odds ratio, prioritizing thus the anticipation of difficult laryngoscopies.http://www.sciencedirect.com/science/article/pii/S0104001421003584Airway managementLaryngoscopyIntubation, intratrachealSensitivity and specificity |
| spellingShingle | Cl.ístenes C. de Carvalho Danielle M. da Silva Marina S. Leite Fl..via A. de Orange Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds Brazilian Journal of Anesthesiology Airway management Laryngoscopy Intubation, intratracheal Sensitivity and specificity |
| title | Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds |
| title_full | Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds |
| title_fullStr | Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds |
| title_full_unstemmed | Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds |
| title_short | Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds |
| title_sort | is mallampati classification a good screening test a prospective cohort evaluating the predictive values of mallampati test at different thresholds |
| topic | Airway management Laryngoscopy Intubation, intratracheal Sensitivity and specificity |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421003584 |
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