Thyromental height test promising in difficult entubations,claims study

Research has provided evidence that the thyromental height test is promising, given its higher sensitivity, reasonable specificity, and wider potential for application in the Emergency Department as an Effective Airway Evaluation Tool.The recent findings have been put forth in Annals of Emergency Medicine.

Anatomic airway assessment attempts to predict difficulty in visualizing the vocal cords and delivering an endotracheal tube past them. It is obtained mostly through history and physical examination, which includes specific airway examinations.

Taking into account the limitations of commonly used airways screening examinations, increasing data suggest the utility of newer screening examinations; notably, the thyromental height test and upper lip bite test. The thyromental height test in particular has significantly outperformed traditional examinations, although further research is required.

So, researchers sought to review the evidence behind these 2 newer examinations, as well as to highlight areas in which further research is required for accurate application in the ED and emergency medical services (EMS) settings.

Addressing the fact of anatomic difficulty in laryngoscopy and intubation, the authors wrote "Given the poor performance of traditional airway examinations in the ED, many clinicians perform airway assessments using clinician judgment alone. The fact that these examinations have not been compared with judgment in the literature is part of an overarching research theme neglecting the critical value of clinician judgment. Like many examinations performed in the ED, airway examinations (particularly solo examinations) may not be able to provide a definitive and accurate answer to the question of intubation difficulty."

Focusing on the efficacy of the thyromental height test, the team highlighted that "the thyromental height test's superior test performance may be derived from the functional anatomy it measures. Furthermore, the thyromental height test has several other advantages over traditional airway examinations, especially in the ED setting. It can be measured without patient participation or spinal manipulation, which is particularly useful in uncooperative or immobilized patients, but which is a weakness of almost all traditional examinations. Finally, it is fast, easy, and reliable even when performed by providers with minimal training, making it ideal for an impending or emergency intubation."

Deriving a conclusion weighing the advantages and limitations of the thyromental height test,the team opined ,"Future studies of the utility of the thyromental height test in the ED environment should focus on a more practical and reproducible instrument for measuring thyromental height, as well as further research into its variable performance when stratified by age, sex, and race. In conclusion, we should reevaluate our approach to teaching airway assessment to maximize patient and provider safety and minimize the difficulty of learning this critical skill."

For full article, follow the link: https://doi.org/10.1016/j.annemergmed.2020.10.010

Primary source: Annals of Emergency Medicine