Inter-observer reliability of ten tests used for predicting difficult tracheal intubation

• Published in: Canadian journal of anesthesia Vol. 43; no. 6; pp. 554 - 559
• Main Authors: KARKOUTI, K, ROSE, D. K, FERRIS, L. E, WIGGLESWORTH, D. F, MEISAMI-FARD, T, LEE, H
• Format: Journal Article
• Language: English
• Published: Toronto, ON Canadian Anesthesiologists' Society 01.06.1996
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atlanto-Occipital Joint - anatomy & histology; Bias; Biological and medical sciences; Chin - anatomy & histology; Elective Surgical Procedures; Face; Forecasting; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Intubation, Intratracheal - statistics & numerical data; Mandible - anatomy & histology; Mandible - physiology; Medical sciences; Mouth - anatomy & histology; Movement; Neck - anatomy & histology; Observer Variation; Oropharynx - anatomy & histology; Prospective Studies; Reproducibility of Results; Thyroid Gland; Human; Interindividual comparison; Prediction; General anesthesia; Complication; Exploration; Intubation; Preoperative; Reliability; Trachea
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03011765

To determine inter-observer reliability of ten preoperative airway assessment tests used for predicting difficult tracheal intubation. 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). 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. 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 tracheal intubation.