title: Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices.
abstract: OBJECTIVE
  Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients.
  
  
  METHODS
  A total of 60 diabetic patients undergoing general anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack-Lehane scores were noted. Statistical analysis was performed using Fischer exact test.
  
  
  RESULTS
  Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.
  
  
  CONCLUSIONS
  The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.
authors.affiliation: Department of Anaesthesiology, Regional Cancer Centre, Trivandrum, Kerala, India.
authors.forename: Kv
authors.initials: K
authors.lastname: Hashim
authors.affiliation: Department of Anaesthesiology, Regional Cancer Centre, Trivandrum, Kerala, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Thomas
keywords: Diabetes; difficult intubation; limited joint mobility