Agreement between the objective and subjective evaluation for predicting and finding a difficult airway
Abstract
Introduction. When assessing the airway, there are multiple factors that hinder the accurate prediction of the degree of difficulty for airway management. During the physical examination, disagreement among the physicians with regards to the definition and use of predictive factors of a difficult airway is crucial. Most assessments are subjective, not all the validated predictors are used and usually the assessment is made in an emergency setting with the patient in decubitus position, giving rise to disagreement in the Diagnosis of a difficult airway.
Objective. To assess the agreement between objective and subjective predictions and the finding of a difficult airway in a sitting and decubital position, by anesthesiologists and residents.
Materials and Methods. This was a trial for evaluating diagnostic technology. The estimated sample included 116 patients with 100 % follow-up. The patients were from the Santander University Hospital with a 1 - 3 ASA score. Agreement was established using kappa values. Every predictor was evaluated for performance (sensitivity, specificity, prognostic values) and finally, a logistic regression model was developed.
Results. The level of agreement between the objective and subjective evaluation of the difficult airway in both positions was poor. The Mallampatti classification gave the best kappa index (0,20). Intraobserver agreement was excellent or good. In general, all predictors were specific and low in sensitivity. Just the mouth opening and Mallampati classification in the predictive model exhibited a significant odds ratio (OR), which stresses the believe that an accurate oral cavity evaluation is an appropriate predictor for a difficult airway.
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