Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.06.015
Brazilian Journal of Anesthesiology
Systematic Review

Predictive performance of thyromental height for difficult laryngoscopies in adults: a systematic review and meta-analysis

Desempenho preditivo da altura tireomentoniana para laringoscopias difíceis em adultos: uma revisão sistemática e meta-análise

Clístenes Crístian de Carvalho, Jayme Marques Santos Neto, Flávia Augusta de Orange

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Abstract

Background
Thyromental height (TMH) was first reported as a great single test for prediction of difficult laryngoscopies, although further studies have shown variable estimates of its accuracy. We thus performed this meta-analysis to summarize the predictive values of TMH mainly for prediction of difficult laryngoscopies.

Methods
A search in PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included prospective cohorts fully reported with patients ≥ 16 years old, providing data on predictive values of TMH for prediction of either difficult laryngoscopies or difficult intubations. Diagnostic properties and association between TMH and Cormack and Lehanes’s classification by direct laryngoscopy were evaluated. A random-effects meta-analysis using hierarchical models was performed.

Results
Eight studies evaluating 2844 patients were included. All included studies had high risk of bias and low concern regarding applicability. There was significant heterogeneity among the studies. The pooled diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios were as follows: DOR, 57.94 (95% CI: 18.19–184.55); LR+, 11.32 (95% CI: 4.28–29.92); and LR-, 0.23 (95% CI: 0.15–0.35). Summary sensitivity and specificity for studies with common threshold were 82.6 (95% CI: 74–88.8%) and 93.5 (95% CI: 79–98.2%), respectively. The estimated AUC was 81.1%.

Conclusion
TMH arises as a good predictor of difficult laryngoscopies in adult patients from diverse populations presenting better predictive values than most previously reported bedside tests. However, the high risk of bias throughout the studies may have skewed the results of the individual research as well as the summary points of the present meta-analysis.

Keywords

Airway management;  Laryngoscopy;  Intubation, intratracheal;  Systematic review;  Meta-analysis;  Sensitivity and specificity

Resumo

Introdução

A altura tireomentoniana (ATM) foi relatada pela primeira vez como um ótimo teste único para prever laringoscopias difíceis, embora estudos posteriores tenham mostrado estimativas variáveis de sua precisão. Portanto, realizamos esta meta-análise para resumir os valores preditivos de ATM principalmente para predição de laringoscopias difíceis.

Métodos

Uma pesquisa no PubMed, EMBASE, LILACS e Scielo foi realizada em junho de 2020. Incluímos coortes prospectivas totalmente relatadas com pacientes ≥ 16 anos, fornecendo dados sobre valores preditivos de ATM para predição de laringoscopias difíceis ou intubações difíceis. As propriedades diagnósticas e a associação entre TMH e a classificação de Cormack e Lehanes por laringoscopia direta foram avaliadas. Uma meta-análise de efeitos aleatórios usando modelos hierárquicos foi realizada.

Resultados

Oito estudos avaliando 2.844 pacientes foram incluídos. Todos os estudos incluídos tinham alto risco de viés e baixa preocupação quanto à aplicabilidade. Houve heterogeneidade significativa entre os estudos. A razão de chances de diagnóstico combinada (DOR) e as razões de verossimilhança positiva (LR+) e negativa (LR-) foram as seguintes: DOR, 57,94 (95% IC: 18,19–184,55); LR+, 11,32 (95% IC: 4,28–29,92); e LR-, 0,23 (95% IC: 0,15–0,35). Sensibilidade e especificidade resumidas para estudos com limiar comum foram 82,6 (95% IC: 74–88,8%) e 93,5 (95% IC: 79–98,2%), respectivamente. A AUC estimada foi de 81,1%.

Conclusão

A ATM surge como um bom preditor de laringoscopias difíceis em pacientes adultos de diversas populações, apresentando melhores valores preditivos do que a maioria dos testes à beira do leito relatados anteriormente. No entanto, o alto risco de viés ao longo dos estudos pode ter distorcido os resultados da pesquisa individual, bem como os pontos resumidos da presente meta-análise.

Palavras-chave

Manejo de vias aéreas; Laringoscopia; Intubação intratraqueal; Revisão sistemática; Meta-análise; Sensibilidade e especificidade

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