Key result
Ruler measurement of thyromental distance increased test sensitivity for predicting difficult intubation to 48% (95% CI 43-53) compared to 16% (95% CI 14-19) without a ruler.
Why the study?
Does ruler measurement of thyromental distance improve sensitivity for predicting difficult intubation compared to measurement without a ruler?
Meta-Analysis
Does ruler measurement of thyromental distance improve sensitivity for predicting difficult intubation compared to measurement without a ruler?
Absolute Event Rate: 48% vs 16%
Using a ruler rather than fingers to measure thyromental distance significantly improves the sensitivity of predicting difficult intubation.
Ruler measurement of thyromental distance improves difficult intubation prediction; extends meta-analytic evidence supporting standardized bedside use.
Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. Of respondents, 72% used fingers for TMD measurement and also considered three finger widths the minimum acceptable TMD. In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6-7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43-53) vs 16% (95% CI 14-19) without a ruler), when predicting difficult intubation.
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Baker et al. (2009) conducted a meta-analysis in Difficult intubation. Ruler measurement of thyromental distance vs. Measurement without a ruler (e.g., using fingers) was evaluated on Test sensitivity for predicting difficult intubation. Ruler measurement of thyromental distance increased test sensitivity for predicting difficult intubation to 48% (95% CI 43-53) compared to 16% (95% CI 14-19) without a ruler.
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