Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Anaesthesia. 2024 Nov;79(11):1201-1211. doi: 10.1111/anae.16394. Epub 2024 Aug 7.
The VIDIAC score, a prospectively developed universal classification for videolaryngoscopy, has shown excellent diagnostic performance in adults. However, there is no reliable classification system for videolaryngoscopic tracheal intubation in children. We aimed to develop and validate a multivariable logistic regression model and easy-to-use score to classify difficult videolaryngoscopic tracheal intubation in children and to compare it with the Cormack and Lehane classification. A secondary aim was to externally validate the VIDIAC score in children.
We conducted a prospective observational study within a structured universal videolaryngoscopy implementation programme. We used C-MAC™ videolaryngoscopes in all children undergoing tracheal intubation for elective surgical procedures. We validated the VIDIAC score externally and assessed its performance. We then identified eligible co-variables for inclusion in the PeDiAC score, developed a multivariable logistic regression model and compared its performance against the Cormack and Lehane classification.
We studied 809 children undergoing 904 episodes of tracheal intubation. The VIDIAC score outperformed the Cormack and Lehane classification when classifying the difficulty of videolaryngoscopic tracheal intubation, with an area under the receiver operating characteristic curve of 0.80 (95%CI 0.73-0.87) vs. 0.69 (95%CI 0.62-0.76), respectively, p = 0.018. Eight eligible tracheal intubation-related factors, that were selected by 100-times repeated 10-fold cross-validated least absolute shrinkage selector operator regression, were used to develop the PeDiAC model. The PeDiAC model and score showed excellent diagnostic performance and model calibration. The PeDiAC score achieved significantly better diagnostic performance than the Cormack and Lehane classification, with an area under the receiver operating characteristic curve of 0.97 (95%CI 0.96-0.99) vs. 0.69 (95%CI 0.62-0.76), respectively, p < 0.001.
We developed and validated a specifically tailored classification for paediatric videolaryngoscopic tracheal intubation with excellent diagnostic performance and calibration that outperformed the Cormack and Lehane classification.
VIDIAC 评分是一种前瞻性开发的用于视频喉镜的通用分类方法，在成人中显示出出色的诊断性能。然而，目前还没有可靠的儿童视频喉镜气管插管分类系统。我们旨在开发和验证一个多变量逻辑回归模型和易于使用的评分系统，以对儿童困难的视频喉镜气管插管进行分类，并将其与 Cormack 和 Lehane 分类进行比较。次要目标是在儿童中外部验证 VIDIAC 评分。
我们在一个结构化的通用视频喉镜实施计划中进行了前瞻性观察研究。我们在所有接受择期手术的儿童中使用 C-MAC™视频喉镜进行气管插管。我们对 VIDIAC 评分进行了外部验证，并评估了其性能。然后，我们确定了适合纳入 PeDiAC 评分的协变量，开发了一个多变量逻辑回归模型，并将其与 Cormack 和 Lehane 分类进行了比较。
我们研究了 809 名儿童进行的 904 次气管插管。VIDIAC 评分在对视频喉镜气管插管的难度进行分类时优于 Cormack 和 Lehane 分类，ROC 曲线下面积分别为 0.80（95%CI 0.73-0.87）和 0.69（95%CI 0.62-0.76），p=0.018。通过 100 次重复 10 倍交叉验证最小绝对收缩选择算子回归选择了 8 个与气管插管相关的合格因素，用于开发 PeDiAC 模型。PeDiAC 模型和评分显示出出色的诊断性能和模型校准。PeDiAC 评分的诊断性能明显优于 Cormack 和 Lehane 分类，ROC 曲线下面积分别为 0.97（95%CI 0.96-0.99）和 0.69（95%CI 0.62-0.76），p<0.001。
我们开发并验证了一种专门针对儿科视频喉镜气管插管的分类方法，具有出色的诊断性能和校准，优于 Cormack 和 Lehane 分类。
