Faramarzi Elnaz, Soleimanpour Hassan, Khan Zahid Hussain, Mahmoodpoor Ata, Sanaie Sarvin
Elnaz Faramarzi Assistant Professor, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Hassan Soleimanpour Professor of Anesthesiology, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Pak J Med Sci. 2018 Jul-Aug;34(4):1019-1023. doi: 10.12669/pjms.344.15364.
Upper lip bite test (ULBT) is one of the various bedside tests used for prediction of difficult laryngoscopic intubation. However, its usefulness is not still very clear, and there is controversy regarding its accuracy. The aim of this systematic review was to determine the accuracy of the ULBT for predicting difficult airway including difficult laryngoscopy or difficult tracheal intubation.
We searched the databases of PubMed, Scopus, and Google scholar for prospective studies published up until October 2016 assessing the accuracy of ULBT in comparison to Cormack-Lehane grading. The selected keywords were "upper lip bite test", "upper lip catch test", "prediction", "difficult airway", "difficult laryngoscopy", "difficult intubation". Inclusion criteria were studies assessing ULBT for prediction of difficult intubation, considering Cormack-Lehane grade III and IV as difficult airway, written in English, and reporting sensitivity, specificity, NPV, PPV, and accuracy. Exclusion criteria were studies not reporting accuracy or not having enough data for its calculation. Based on the mentioned criteria, 27 studies enrolling 18141 patients were included. This systematic review was performed based on the guidelines on conducting systematic reviews of diagnostic studies.
Prevalence of airway difficulties according to the direct laryngoscopic view varied from 2.8% to 27% and according to the ULBT was from 2% to 21%. In 11 of the 27 studies, sensitivity of ULBT in prediction of difficult airway was more than 70%. All of the studies except one showed a high specificity for ULBT (>85%). Moreover, these studies indicated a high NPV. Accuracy of ULBT was >85% in 24 out of 27 studies.
It appears that ULBT is a useful bedside test for evaluation of patient airway before the general anesthesia.
上唇咬试验（ULBT）是用于预测困难喉镜插管的多种床旁检查之一。然而，其效用仍不是很明确，并且关于其准确性存在争议。本系统评价的目的是确定ULBT预测包括困难喉镜检查或困难气管插管在内的困难气道的准确性。
我们检索了PubMed、Scopus和谷歌学术数据库，以查找截至2016年10月发表的前瞻性研究，这些研究评估了ULBT与Cormack-Lehane分级相比的准确性。所选关键词为“上唇咬试验”、“上唇捕捉试验”、“预测”、“困难气道”、“困难喉镜检查”、“困难插管”。纳入标准为评估ULBT预测困难插管的研究，将Cormack-Lehane III级和IV级视为困难气道，以英文撰写，并报告敏感性、特异性、阴性预测值、阳性预测值和准确性。排除标准为未报告准确性或没有足够数据进行计算的研究。根据上述标准，纳入了27项研究，共18141例患者。本系统评价是根据诊断研究系统评价指南进行的。
根据直接喉镜检查，气道困难的发生率为2.8%至27%，根据ULBT为2%至21%。在27项研究中的11项中，ULBT预测困难气道的敏感性超过70%。除一项研究外，所有研究均显示ULBT具有高特异性（>85%）。此外，这些研究显示阴性预测值较高。27项研究中的24项ULBT准确性>85%。
似乎ULBT是全身麻醉前评估患者气道的一种有用的床旁检查。
