title: Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies.
abstract: BACKGROUND
  Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need.
  
  
  METHODS
  486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion.
  
  
  RESULTS
  Sixty seven (13.7%) patients required tracheostomy for their peri-operative management. Elective tracheostomies were done in 53 cases during surgery and post-operatively in 14 patients. All patients in whom tracheostomies were anticipated had a score of seven or more.
  
  
  CONCLUSIONS
  A decision on whether or not an elective tracheotomy in head and neck surgery is necessary and can be facilitated using CASST criterion, which has a sensitivity of 95.5% and a negative predictive value (NPV) of 99.3%. It may reduce post-operative complications and contribute to safer treatment.
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India. Electronic address: guptakaran86@gmail.com.
authors: Karan
authors: K
authors: Gupta
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Dushyant
authors: D
authors: Mandlik
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Daxesh
authors: D
authors: Patel
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Purvi
authors: P
authors: Patel
authors: Department of Anaesthesiology and Critical Care, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Bankim
authors: B
authors: Shah
authors: Department of Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Devanhalli G
authors: DG
authors: Vijay
authors: Department of Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Jagdish M
authors: JM
authors: Kothari
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Rajendra B
authors: RB
authors: Toprani
authors: Department of Head & Neck Surgical Oncology, Aastha Oncology Associates, HCG Cancer Centre, Ahmedabad, Gujarat, India.
authors: Kaustubh D
authors: KD
authors: Patel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014139:Tracheostomy / Q000706:statistics & numerical data*; D014313:Trismus
keywords: Airway management; Oral and oropharyngeal cancer; Risk analysis system; Tracheostomy