An Evaluation of the Efficacy of Predictive Tests and Anthropometric Measurements in Determining Difficult Intubation in Children

Abstract

Objective: Determining risk factors prior to intubation is crucial for patient safety. This study aimed to assess the usability of the predictive tests and anthropometric measurements in identifying potential difficult intubation in children. Materials and Methods: This prospective study involved 200 pediatric patients aged 7 to 15 years who were scheduled to receive general anesthesia and were classified as American Society of Anesthesiologists (ASA) I-II with no pre-existing airway issues. Patients were categorized based on age into three groups: Group 1 (7–9 years, n=69), Group 2 (10–12 years, n=65), and Group 3 (13–15 years, n=66). Modified Mallampati Classification (MMC), mandibular protrusion (MP), tooth anomalies (missing tooth, decayed tooth, protruding upper incisor, and long upper incisor), thyromental distance (TMD), sternomental distance (SMD), and atlanto-occipital joint mobility (AOJM1 and AOJM2) were determined for each patient. These prediction tests were then compared with the Cormack–Lehane (CL) classification. Results: Statistically significant differences were observed between the groups in terms of TMD, SMD, and missing tooth. The MMC exhibited the highest sensitivity and positive predictive value (PPV) (100% and 47%, respectively), while the MP had the highest specificity (94.5%). It was predicted that reference values of ≤ 6 cm for TMD and ≤ 12 cm for SMD would yield very low sensitivity and PPV for Group 1. Conclusion: Reference values of ≤ 5 cm for TMD and ≤ 10 cm for SMD were found to provide useful predictive information for children aged 7–9 years.