Physical examination tests for detecting difficult airway management in adult patients
Citation: Roth D, Pace NL, Lee A, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database of Systematic Reviews 2018; (5): CD008874
What is this? Some patients with COVID-19 will become critically ill, and have a higher risk of airway complications. These are potentially life-threatening events, particularly if the difficulties with the airway are unanticipated. Several bedside tests have been used to screen for difficult airways.
In this Cochrane systematic review, the authors searched for studies of the accuracy of airway assessment tests in adults. They did not restrict their searches by date, type or language of publication and did them in December 2016. They included 127 cohort type studies and 6 case-control studies (total: 844,206 participants). These evaluated seven different pre-specified index tests, as well as 69 that had not been pre-specified, and 32 combinations of test. They also identified 27 studies that are awaiting classification for the review.
What works: For difficult laryngoscopy, the upper lip bite test showed the most favorable diagnostic test accuracy properties.
What doesn’t work: Nothing noted.
What’s uncertain: In general, bedside airway tests have relatively low sensitivity and limited accuracy, so their effectiveness is uncertain.
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