title: Prediction of difficult intubations using conventional indicators: Does rapid sequence intubation ease difficult intubations? A prospective randomised study in a tertiary care teaching hospital.
abstract: BACKGROUND
  Endotracheal intubations performed in the Emergency Department.
  
  
  OBJECTIVE
  To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI) on ease of intubation.
  
  
  METHODS
  A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months.
  
  
  METHODS
  Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed.
  
  
  METHODS
  Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups.
  
  
  RESULTS
  Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack-Lehane score, 3 or 4). Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations.
  
  
  CONCLUSIONS
  An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.
authors.affiliation: Department of Emergency Medicine, St. Johns' Medical College and Hospital, Bangalore, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Gangadharan
authors.forename: C
authors.initials: C
authors.lastname: Sreekanth
authors.forename: Mabel C
authors.initials: MC
authors.lastname: Vasnaik