title: Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool.
abstract: BACKGROUND
  Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration.
  
  
  METHODS
  After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery.
  
  
  RESULTS
  Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3% vs 84.3%, P=0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P=0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate=0.00068, P=0.031).
  
  
  CONCLUSIONS
  The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme.
authors.affiliation: Department of Anesthesiology, University of Texas Health Science Center Medical School at Houston, 6431 Fannin Street, Houston, TX 77030, USA. davide.cattano@uth.tmc.edu
authors.forename: D
authors.initials: D
authors.lastname: Cattano
authors.forename: P V
authors.initials: PV
authors.lastname: Killoran
authors.forename: D
authors.initials: D
authors.lastname: Iannucci
authors.forename: V
authors.initials: V
authors.lastname: Maddukuri
authors.forename: A V
authors.initials: AV
authors.lastname: Altamirano
authors.forename: S
authors.initials: S
authors.lastname: Sridhar
authors.forename: C
authors.initials: C
authors.lastname: Seitan
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: C A
authors.initials: CA
authors.lastname: Hagberg
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis*; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004521:Educational Measurement / Q000379:methods* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D057234:Preoperative Period; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012307:Risk Factors; D016037:Single-Blind Method
keywords: airway; education, medical students