Savatmongkorngul Sorravit, Pitakwong Panrikan, Sricharoen Pungkava, Yuksen Chaiyaporn, Jenpanitpong Chetsadakon, Watcharakitpaisan Sorawich
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Open Access Emerg Med. 2022 Jun 29;14:311-322. doi: 10.2147/OAEM.S372768. eCollection 2022.
Difficult laryngoscopy is associated with difficult intubation, an increasing number of endotracheal intubation attempts, and adverse events. Clinical prediction of difficult airways in an emergency setting was limited in sensitivity and specificity. This study developed a new model for predicting difficult laryngoscopy in the emergency department.
This retrospective cohort study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital. The study was conducted from June 2018 to July 2020. The eligibility criteria were an age of ≥15 years who undergo intubation in the emergency department. Difficult laryngoscopy was defined as a Cormack-Lehane grade 3 and above. The predictive model and score were developed by multivariable logistic regression analysis.
A total of 617 patients met the eligibility criteria; 83 (13.45%) had difficult laryngoscopy. Five independent factors were predictive of difficult laryngoscopy. Significant factors were M: limited mouth opening, O: presence of obstructed airway, N: poor neck mobility, T: large tongue, and H: short hypo-mental distance. The difficult laryngoscopy score had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult laryngoscopy by 7.62 times.
The MONTH Difficult Laryngoscopy Score of >4 was associated with difficult laryngoscopy.
困难喉镜检查与困难插管、气管插管尝试次数增加及不良事件相关。急诊情况下困难气道的临床预测在敏感性和特异性方面存在局限性。本研究开发了一种用于预测急诊科困难喉镜检查的新模型。
本回顾性队列研究在拉玛蒂博迪医院急诊科采用探索性模型进行。研究于2018年6月至2020年7月进行。纳入标准为年龄≥15岁且在急诊科接受插管的患者。困难喉镜检查定义为Cormack-Lehane分级3级及以上。通过多变量逻辑回归分析建立预测模型和评分。
共有617例患者符合纳入标准；83例（13.45%）存在困难喉镜检查情况。五个独立因素可预测困难喉镜检查。显著因素包括M：张口受限、O：气道阻塞、N：颈部活动度差、T：舌头大、H：颏下距离短。困难喉镜检查评分的准确率为89%。评分>4使困难喉镜检查的似然比增加7.62倍。
MONTH困难喉镜检查评分>4与困难喉镜检查相关。
