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BJA Advance Access originally published online on October 25, 2007
British Journal of Anaesthesia 2007 99(6):906-911; doi:10.1093/bja/aem297
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Predictive value of the El-Ganzouri multivariate risk index for difficult tracheal intubation: a comparison of Glidescope® videolaryngoscopy and conventional Macintosh laryngoscopy

P. Cortellazzi1,*, L. Minati2, C. Falcone3, M. Lamperti1 and D. Caldiroli1

1 Neuroanaesthesia Department
2 Scientific Direction Unitand
3 Neuroepidemiology Department, Fondazione Istituto Neurologico Carlo Besta IRCCS, Via Celoria, 11, I-20133 Milano, MI, Italy

* Corresponding author. E-mail: pcortellazzi{at}istituto-besta.it; lminati{at}istituto-besta.it

Background: The predictive value of the El-Ganzouri risk index (EGRI) for difficult intubation has been evaluated using Macintosh laryngoscopy as reference standard. The Glidescope® videolaryngoscope provides improved visualization of the glottis. We studied the predictive value of the EGRI using videolaryngoscopy as reference standard.

Methods: Data from two subsequent groups of patients, intubated with Macintosh laryngoscopy (ML, n = 994) and videolaryngoscopy (VL, n = 843), were retrospectively analysed. The EGRI was taken as index test. The two types of laryngoscopy were adopted as reference for the presence of Cormack and Lehane grading III–IV. For both groups, sensitivity, specificity, and positive and negative post-test probabilities (PTP) were calculated for thresholds on the EGRI scale. Receiver operating characteristic curves and corresponding areas (AUC) were obtained.

Results: Sensitivity and specificity were 69.7% and 66.3% at the cut-off value of 2 in the ML group, and 93.3% and 76.6% at the cut-off value of 3 in the VL group. Corresponding positive and negative PTP were 12.81% and 3.15% in the ML group, and 6.73% and 0.16% in the VL group. At the threshold of 4, positive and negative PTP were 31.34% and 4.85% in the ML group. At the threshold of 7, positive and negative PTP were 85.71% and 1.08% in the VL group. The AUC was 0.74 in the ML group and 0.91 in the VL group.

Conclusions: The predictive value of the EGRI may have been underestimated due to limited accuracy of Macintosh laryngoscopy. Using videolaryngoscopy, the EGRI might be reconsidered as a decisional tool.

Keywords: complications, intubation tracheal; equipment, laryngoscopes; larynx, laryngoscopy; risk


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A Defining View of the Video Laryngoscope
Robert M. Knapp
British Journal of Anaesthesia, 29 Feb 2008 [Full text]

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