ORIGINAL ARTICLE

Can an airway assessment score predict difficulty at intubation in the emergency department?

M J Reed¹, M J G Dunn¹, D W McKeown²

¹ Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
² Anaesthetic Department, Royal Infirmary of Edinburgh

Correspondence to:
Correspondence to:
Dr M J Reed
Emergency Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; mattreed1{at}hotmail.com

Aim: To assess whether an airway assessment score based on the LEMON method is able to predict difficulty at intubation in the emergency department.

Methods: Patients requiring endotracheal intubation in the resuscitation room of a UK teaching hospital between June 2002 and September 2003 were assessed on criteria based on the LEMON method. At laryngoscopy, the Cormack and Lehane grade was recorded. An airway assessment score was devised and assessed.

Results: 156 patients were intubated during the study period. There were 114 Cormack and Lehane grade 1 intubations, 29 grade 2 intubations, 11 grade 3 intubations, and 2 grade 4 intubations. Patients with large incisors (p<0.001), a reduced inter-incisor distance (p<0.05), or a reduced thyroid to floor of mouth distance (p<0.05) were all more likely to have a poor laryngoscopic view (grade 2, 3, or 4). Patients with a high airway assessment score were more likely to have a poor laryngoscopic view compared with those patients with a low airway assessment score (p<0.05).

Conclusions: An airway assessment score based on criteria of the LEMON method is able to successfully stratify the risk of intubation difficulty in the emergency department. Patients with a poor laryngoscopic view (grades 2, 3, or 4) were more likely to have large incisors, a reduced inter-incisor distance, and a reduced thyroid to floor of mouth distance. They were also more likely to have a higher airway assessment score than those patients with a good laryngoscopic view.

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• Walz, J. M., Zayaruzny, M., Heard, S. O. (2007). Airway Management in Critical Illness. Chest 131: 608-620 [Abstract] [Full Text]  
• (2005). Airway Assessment Using "LEMON" Score Predicts Difficult ED Intubation. JWatch Emergency Med. 2005: 1-1 [Full Text]  

eLetters:

Read all eLetters

A limited place for the LEMON score in airway assessment

Susan Dorrian, et al.

EMJ Online, 16 Mar 2005 [Full text]

Letter to the Editor

Michael F. Murphy

EMJ Online, 21 Mar 2005 [Full text]

Assessment score or not !!

Anthony Cubb

EMJ Online, 26 Apr 2005 [Full text]

I want to know

Kittima Rodgerd

EMJ Online, 7 Apr 2007 [Full text]