Physical examination tests for detecting difficult airway management in adult patients

Added March 24, 2020

Citation: Roth D, Pace NL, Lee A, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database of Systematic Reviews 2018; (5): CD008874

What is this? Some patients with COVID-19 will become critically ill, and have a higher risk of airway complications. These are potentially life-threatening events, particularly if the difficulties with the airway are unanticipated. Several bedside tests have been used to screen for difficult airways.

In this Cochrane systematic review, the authors searched for studies of the accuracy of airway assessment tests in adults. They did not restrict their searches by date, type or language of publication and did them in December 2016. They included 127 cohort type studies and 6 case-control studies (total: 844,206 participants). These evaluated seven different pre-specified index tests, as well as 69 that had not been pre-specified, and 32 combinations of test. They also identified 27 studies that are awaiting classification for the review.

What works: For difficult laryngoscopy, the upper lip bite test showed the most favorable diagnostic test accuracy properties.

What doesn’t work:  Nothing noted.

What’s uncertain: In general, bedside airway tests have relatively low sensitivity and limited accuracy, so their effectiveness is uncertain.


Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.