scholarly journals Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index

1998 ◽  
Vol 80 (2) ◽  
pp. 140-146 ◽  
Author(s):  
J Arné ◽  
P Descoins ◽  
J Fusciardi ◽  
P Ingrand ◽  
B Ferrier ◽  
...  
Keyword(s):  
Difficult Intubation ◽  
Predictive Value ◽  
Risk Index ◽  
Preoperative Assessment ◽  
Multivariate Risk ◽  
Ent Surgery

PREOPERATIVE ASSESSMENT OF VARIABLES TO PREDICT DIFFICULT INTUBATION IN PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

2021 ◽  
pp. 68-71
Author(s):  
Veena Chatrath ◽  
Leena Mahajan ◽  
Gagandeep Kaur ◽  
Ankita Taneja ◽  
Ranjana Khetarpal ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Risk Index ◽  
Preoperative Assessment ◽  
High Sensitivity ◽  
Screening Tests ◽  
Failed Intubation ◽  
Upper Lip ◽  
Number Of Patients

Background- Advance prediction of difcult airway provides us ample time for optimal preparation of equipment and participation of experienced anaesthesiologist to handle difcult airway. The present study was designed to evaluate the efcacy of Upper Lip Bite Test (ULBT), Ratio of neck circumference (NC) and thyromental distance (TMD) and Arne Risk Index in predicting difcult airway. Material and methods-This prospective observational study was conducted on 250 patients, aged 18-60 years of ASAgrade I and II scheduled for surgeries under general anaesthesia. Three screening tests i.e. ULBT, NC/TMD and Arne Risk Index were used to predict difcult airway. Number of patients successfully intubated, number of attempts taken for intubation and time taken for intubation was noted. Difcult intubation was calculated using Intubation Difculty Score (IDS). All the three screening tests were compared for their sensitivity, specicity, negative predictive value (NPV) and Positive predictive value (PPV) to predict difcult airway. Result- The incidence of difcult intubation was found to be 6.8%. 233 (95.2%) patients were intubated in rst attempt and 12 (4.8%) patients were intubated in second attempt and there was no failed intubation. Arne Risk Index had high sensitivity (88.23%), high specicity (88.84%), highest NPV (99.04%) and PPV of 36.58%. ULBThas sensitivity of 76.47%, specicity of 88.41%, NPV of 98.09% and PPV of 32.50% and NC/TMD has sensitivity of 47.05%, specicity of 87.98%, PPVof 22.22% and NPVof 95.79% in predicting difcult airway. Conclusion- Arne Risk index, a multivariate clinical risk index had highest sensitivity, specicity, NPVand PPVto predict difcult airway.

scholarly journals ACCURACY OF THE UPPER LIP BITE TEST;

2012 ◽  
Vol 20 (01) ◽  
pp. 132-138
Author(s):  
MUHAMMAD ATIF ◽  
MUHAMMAD ABDULLAH ◽  
MUHAMMAD JAVAD YOUSAF ◽  
Khalid Buland
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Military Hospital ◽  
Upper Lip ◽  
Cross Sectional ◽  
Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

Determining predictive value of preoperative tests for difficult intubation

2017 ◽  
Vol 39 ◽  
pp. 120-121 ◽  
Author(s):  
Jin-Hua Jin ◽  
Fu-Shan Xue ◽  
Ya-Yang Liu ◽  
Hui-Xian Li
Keyword(s):  
Difficult Intubation ◽  
Predictive Value

scholarly journals Functional MRI in the pre-operative assessment of GI-RADS 3, 4, and 5 ovarian masses

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Rania S. M. Ibrahim ◽  
Manar A. E. L. O. Maher ◽  
Solava Abdalaziz ◽  
Samar Amer ◽  
Doaa Shafie ◽  
...  
Keyword(s):  
Functional Mri ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Preoperative Assessment ◽  
Lesion Detection ◽  
Diagnostic Challenge ◽  
Pelvic Mri ◽  
Conventional Mri ◽  
Ovarian Lesion ◽  
Ovarian Masses

Abstract Background Characterization of an ovarian lesion is a diagnostic challenge. A correct preoperative assessment is of great importance so as to arrange adequate therapeutic procedures. The aim of the current study is to evaluate the diagnostic performance of functional MRI in differentiation between malignant, borderline, and benign ovarian masses. Results This study included 56 adnexal lesions. Bilateral synchronous ovarian lesions are detected in 16 cases. Postoperative histologically proved to be benign in 17 (30%), borderline (low potential malignancy) in 12 (22%), and malignant in 27 (48%). The overall diagnostic performance of conventional MRI in the diagnosis of adenexal lesion was a sensitivity of 74%, specificity of 47%, positive predictive value (PPV) of 76%, negative predictive value (NPV) of 44%, and an accuracy of 66%. Functional pelvic MRI examination showed an increase in overall diagnostic performance compared to conventional values with the highest sensitivity of 90% and NPV of 67% using DWI, and the highest specificity of 88%, PPV of 94%, and an accuracy of 82% using DCE MRI. Conclusion Functional MRI in conjugation with conventional MRI plays a key role in the ovarian lesion detection, characterization, and staging. Functional MRI is currently being evaluated as possible predictive and prognostic biomarkers in ovarian lesions.

Rater

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20678-e20678
Author(s):  
B. Rangarajan ◽  
K. Prabhash ◽  
R. Nair ◽  
H. Menon ◽  
P. Jain ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Predictive Value ◽  
Risk Index ◽  
Febrile Episode ◽  
Index Score ◽  
Low Risk ◽  
Mascc Score ◽  
Sensitivity Specificity ◽  
Risk Index Score

e20678 Background: Management of neutropenic fever is based on risk stratification of the episode which helps in optimizing treatment. MASCC is the most commonly used for risk stratification Patients with a score of > 21 were regarded as low risk; patients with a score of <21 were regarded as high risk. We tried to validate the MASCC index for our ethnic population. Methods: Patients were recruited throughout a 12 month period. Inclusion criteria were diagnosis of hematolymphoid malignancy, neutropenic febrile episode secondary to chemotherapy or during induction therapy of acute leukemia and more than 18 years of age All patients were risk stratified, hospitalized and treated with broad-spectrum, empiric, intravenous antibiotic therapy until recovery or outcome of the event. The incidence of medical complications in both groups and death related to the neutropenic infection was recorded. The data was entered on SPSS software and MASCC criteria was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 81 febrile neutropenic episodes were included; 34 classified as low risk and 47 as high risk according to MASCC risk index score. The sensitivity, specificity, PPV, NPV and accuracy of MASCC risk index score were 45.5%, 40%, 11%, 82%, 40.7%. We subsequently analyzed the subset of Acute Myeloid Leukemia (AML) patients as they were the majority comprising of 62/81 episodes. The subset of AML patients risk stratified according to MASCC risk index showed sensitivity, specificity, PPV, NPV and accuracy of 71%, 25.5%, 11%, 87.5%, 31% respectively. Conclusions: In our patient group, the value of MASCC score is limited with poor sensitivity, specificity and PPV. This trend is also seen in the subset analysis of AML patients. The value of the MASCC index with the score of 21 as the cut-off between low risk and high risk seems limited in our patients and requires confirmation with larger set of patients. No significant financial relationships to disclose.

Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

2012 ◽  
Vol 22 (6) ◽  
pp. 1020-1025 ◽  
Author(s):  
Mark H. McComiskey ◽  
W. Glenn McCluggage ◽  
Arthur Grey ◽  
Ian Harley ◽  
Stephen Dobbs ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Endometrial Cancer ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Myometrial Invasion ◽  
Preoperative Assessment ◽  
Tumor Board ◽  
Resonance Imaging ◽  
Outer Half

ObjectivesThe objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging.MethodsThis was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center.ResultsFor the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59–0.83), and specificity was 0.83 (95% CI, 0.76–0.89). The positive predictive value was 0.63 (95% CI, 0.50–0.74), and negative predictive value was 0.89 (95% CI, 0.82–0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87–6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21–0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively).ConclusionsPreoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

scholarly journals What Leads to a Patient Refusal for Ambulatory Surgery? A Logistic Regression Prediction Model Based on a 5-year Retrospective Analysis of Patients with Abdominal Wall Hernia

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
João Oliveira ◽  
Sandra F. Ramos ◽  
Manuel B. Cruz ◽  
Isabel Novais ◽  
Carlos Magalhães ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Abdominal Surgery ◽  
Predictive Value ◽  
Ambulatory Surgery ◽  
Risk Index ◽  
Abdominal Hernia ◽  
Mathematical Tool ◽  
Physical Status ◽  
Patient Refusal

Introduction: Ambulatory surgery has proven benefits in patient wellbeing and cost reduction in healthcare systems. However, some patients referred for ambulatory surgery are refused and directed instead towards inpatient care, which generates several drawbacks. The reasons for this refusal have not been yet studied. The aim of this study is to identify, retrospectively, significant variables associated with patient refusal for ambulatory surgery and develop a mathematical tool able to predict with strong accuracy those who will be rejected.Material and Methods: Over a 5-year period (2014 - 2018), all patients that underwent abdominal hernia repair in our hospital in an inpatient setting, and that had been previously refused for ambulatory surgery, were analysed for a total of 94 variables. A multivariate logistic regression model was developed to identify risk factors associated with refusal using data from 136 patients (65 refused vs 71 accepted). A prediction index for refusal in ambulatory surgery - IRAS - was derived and tested (n = 62 patients).Results: The risk index included five significant risk factors: type 2 diabetes mellitus [OR 14.669 (2.982; 72.154)], physical status [OR 49.155 (15.532; 155.555)], prior malignancy [OR 14.518 (2.653; 79.441)], prior abdominal surgery [OR 3.455 (1.006; 11.866)] and usage of antiplatelet agents [OR 25.600 (4.309; 152.066)]. All risk factors were associated with a high risk of refusal (OR between 3.455 for history of prior abdominal surgery and 49.155 according to the American Society of Anaesthesiologists physical status classification). Defining five points as the maximum IRAS score that predicts suitability for ambulatory surgery resulted in a positive predictive value of 93.55% and negative predictive value of 87.10%.Discussion: Significant patient variables for refusal of an ambulatory procedure were determined and an easy to use risk index - IRAS - was built that is able to predict with good accuracy which patients will be refused.Conclusion: IRAS is a useful tool that can contribute to reduce time to surgery and improve patients’ quality of life.

scholarly journals Comparison of Upper Lip Bite Test with Modified Mallampati Test and Thyromental Distance for Prediction of Difficult Intubation

2020 ◽  
Vol 5 (1) ◽  
pp. 2-9
Author(s):  
Sabin Koirala ◽  
Bigen Man Shakya ◽  
Moda Nath Marhatta
Keyword(s):  
Difficult Intubation ◽  
Predictive Value ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Upper Lip ◽  
Cross Sectional ◽  
Airway Assessment ◽  
Total Percentage ◽  
Bedside Test ◽  
Sensitivity Specificity

Introduction: The prediction of difficult intubation using simple bedside test is of great importance to prevent mismanagement of airway. This study was conducted to compare Upper Lip Bite Test (ULBT) with Modified Mallampati Test (MMT) and Thyromental Distance (TMD) for the prediction of difficult intubation. Method: This was descriptive cross-sectional study conducted in 121 patients of  American Society of Anaesthesiologists Physical Status (ASA PS) I and II patients scheduled for elective surgery requiring general anaesthesia with endotracheal tube. The airway assessment of the patients was done one day prior to the surgery using Upper Lip Bite Test (ULBT), Modified Mallampati Test (MMT) and measurement of Thyromental Distance (TMD) . On the day of surgery during laryngoscopy, Cormack-Lehane (CL) grading was recorded. The CL grading of III and IV was labeled as difficult intubation. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR) of ULBT, MMT and TMD were calculated and compared. Results: The total percentage of difficult intubation, defined by Cormack-Lehane (CL) III and IV was 16.52 %. The sensitivity, specificity, PPV, NPV and accuracy of Upper Lip Bite Test (ULBT) was 50%, 100%, 100%, 91% and 91.74% respectively. ULBT had a significantly higher sensitivity, specificity and PPV when compared to MMT or  TMD or MMT and TMD when combined together. Conclusions:  Upper Lip Bite Test (ULBT) is better   predictor of difficult intubation  and it should be used along with other test during airway assessment.

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