Is Mallampati Class More Consistent and Reliable among Providers When Assessed from Airway Photos?

This is the authors' abstract. We don't add key points for this paper.

Accurate prediction of a difficult airway patient remains a challenge among laryngoscopists and anesthesia providers. Despite the lack of sensitivity and specificity of routine preoperative airway tests, many providers still perform them, suggesting they may still guide and influence airway planning. The most commonly used Mallampati exam has a low sensitivity. Our hypothesis was that digital documentation of the airway exam would improve intraobserver reliability between airway exams and provide more consistent information for airway providers. We obtained written informed consent from 250 patients presenting to the UF Health Shands Presurgical Center to participate in an observational cohort study. Their airway exam was photographed and uploaded into the electronic medical record. Data extracted from the electronic medical record were reviewed by three independent investigators. From chi-square analyses, there were significant differences (p < 0.05) in all measures across raters, indicating raters had varied assessments and predictions about patients. There were no statistically significant associations (p > 0.05) between Mallampati scores from the preassessment or reviews of photographs and the method of intubation or laryngoscopic view observed in the patient. There was also no statistically significant association between the Mallampati score and the use of video laryngoscopy for the intubation method. Moderate intraobserver reliability of the Mallampati exam may be a confounding factor regarding the lack of a significant relationship between the Mallampati exam and the assessment of whether a patient may be difficult to intubate, or the method chosen to facilitate intubation in this study.

Digital airway photos should not guide intubation decisions; leaves open standardized protocols for Mallampati reliability in prospective studies.