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Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients.
Br J Anaesth. 2011 Nov; 107(5):659-67.BJ

Abstract

The modified Mallampati score is used to predict difficult tracheal intubation. We have conducted a meta-analysis of published studies to evaluate the Mallampati score as a prognostic test. A total of 55 studies involving 177 088 patients were included after comprehensive electronic and manual searches. The pooled estimates from the meta-analyses were calculated based on a random-effects model and a summary receiver operating curve. Meta-regression analyses were performed to explore sources of possible heterogeneity between the studies. The summary receiver operating curve demonstrated an area under the curve of 0.75. The pooled odds ratio for a difficult intubation with a modified Mallampati score of III or IV was 5.89 [95% confidence interval (CI), 4.74-7.32]. The pooled estimates of the specificity and sensitivity were 0.91 (CI, 0.91-0.91) and 0.35 (CI, 0.34-0.36), respectively. The pooled positive and negative likelihood ratios were 4.13 (CI, 3.60-4.66) and 0.70 (CI, 0.65-0.75), respectively. The meta-analyses had statistical and clinical heterogeneity ranging from 87.2% to 99.4%. Meta-regression analyses did not identify any significant explanation of the heterogeneity. We conclude that the prognostic value of the modified Mallampati score was worse than that estimated by previous meta-analyses. Our assessment shows that the modified Mallampati score is inadequate as a stand-alone test of a difficult laryngoscopy or tracheal intubation, but it may well be a part of a multivariate model for the prediction of a difficult tracheal intubation.

Links

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Authors+Show Affiliations

Lundstrøm LH
Department of Anaesthesia and Intensive Care, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark.
Vester-Andersen M
No affiliation info available
Møller AM
No affiliation info available
Charuluxananan S
No affiliation info available
L'hermite J
No affiliation info available
Wetterslev J
No affiliation info available
Danish Anaesthesia Database
No affiliation info available

MeSH

Airway ObstructionCohort StudiesHumansIntubation, IntratrachealLaryngoscopyOdds RatioPredictive Value of TestsPrognosisROC CurveSensitivity and Specificity

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21948956

Clinical Trial Links

A Deep Learning Method to Predict Difficult Laryngoscopy Using Cervical Spine X-ray Image

Citation

Lundstrøm, L H., et al. "Poor Prognostic Value of the Modified Mallampati Score: a Meta-analysis Involving 177 088 Patients." British Journal of Anaesthesia, vol. 107, no. 5, 2011, pp. 659-67.
Lundstrøm LH, Vester-Andersen M, Møller AM, et al. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. Br J Anaesth. 2011;107(5):659-67.
Lundstrøm, L. H., Vester-Andersen, M., Møller, A. M., Charuluxananan, S., L'hermite, J., & Wetterslev, J. (2011). Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. British Journal of Anaesthesia, 107(5), 659-67. https://doi.org/10.1093/bja/aer292
Lundstrøm LH, et al. Poor Prognostic Value of the Modified Mallampati Score: a Meta-analysis Involving 177 088 Patients. Br J Anaesth. 2011;107(5):659-67. PubMed PMID: 21948956.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. AU - Lundstrøm,L H, AU - Vester-Andersen,M, AU - Møller,A M, AU - Charuluxananan,S, AU - L'hermite,J, AU - Wetterslev,J, AU - ,, Y1 - 2011/09/26/ PY - 2011/9/28/entrez PY - 2011/9/29/pubmed PY - 2011/12/13/medline SP - 659 EP - 67 JF - British journal of anaesthesia JO - Br J Anaesth VL - 107 IS - 5 N2 - The modified Mallampati score is used to predict difficult tracheal intubation. We have conducted a meta-analysis of published studies to evaluate the Mallampati score as a prognostic test. A total of 55 studies involving 177 088 patients were included after comprehensive electronic and manual searches. The pooled estimates from the meta-analyses were calculated based on a random-effects model and a summary receiver operating curve. Meta-regression analyses were performed to explore sources of possible heterogeneity between the studies. The summary receiver operating curve demonstrated an area under the curve of 0.75. The pooled odds ratio for a difficult intubation with a modified Mallampati score of III or IV was 5.89 [95% confidence interval (CI), 4.74-7.32]. The pooled estimates of the specificity and sensitivity were 0.91 (CI, 0.91-0.91) and 0.35 (CI, 0.34-0.36), respectively. The pooled positive and negative likelihood ratios were 4.13 (CI, 3.60-4.66) and 0.70 (CI, 0.65-0.75), respectively. The meta-analyses had statistical and clinical heterogeneity ranging from 87.2% to 99.4%. Meta-regression analyses did not identify any significant explanation of the heterogeneity. We conclude that the prognostic value of the modified Mallampati score was worse than that estimated by previous meta-analyses. Our assessment shows that the modified Mallampati score is inadequate as a stand-alone test of a difficult laryngoscopy or tracheal intubation, but it may well be a part of a multivariate model for the prediction of a difficult tracheal intubation. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/21948956/Poor_prognostic_value_of_the_modified_Mallampati_score:_a_meta_analysis_involving_177_088_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)32599-0 DB - PRIME DP - Unbound Medicine ER -