title: A documented previous difficult tracheal intubation as a prognostic test for a subsequent difficult tracheal intubation in adults.
abstract: We investigated the diagnostic accuracy of a documented previous difficult tracheal intubation as a stand-alone test for predicting a subsequent difficult intubation. Our assessment included patients from the Danish Anaesthesia Database who were scheduled for tracheal intubation by direct laryngoscopy. We used a four-point scale to grade the tracheal intubation. A previous difficult intubation was defined according to the presence of a record documenting a difficult penultimate tracheal intubation-score for the 15 499 patients anaesthetised more than once. Our assessment demonstrates that a documented history of previous difficult or failed intubation using direct laryngoscopy are strong predictors of a subsequent difficult or failed intubation and may identify 30% of these patients. Although previous investigators have reported predictive values that exceed our findings markedly, a documented previous difficult or failed tracheal intubation appears in everyday anaesthetic practice to be a strong predictor of a subsequent difficult tracheal intubation.
authors.affiliation: Department of Anaesthesia and Intensive Care Herlev, Copenhagen University Hospital, Rigshospitalet, Denmark. lars_hyldborg@hotmail.com
authors.forename: L H
authors.initials: LH
authors.lastname: Lundstrøm
authors.forename: A M
authors.initials: AM
authors.lastname: Møller
authors.forename: C
authors.initials: C
authors.lastname: Rosenstock
authors.forename: G
authors.initials: G
authors.lastname: Astrup
authors.forename: M R
authors.initials: MR
authors.lastname: Gätke
authors.forename: J
authors.initials: J
authors.lastname: Wetterslev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017211:Treatment Failure