FEASIBILITY OF THE PREOPERATIVE MALLAMPATI AIRWAY ASSESSMENT IN EMERGENCY DEPARTMENT PATIENTS

Background: Multiple predictors have been proposed to assist in identifying patient features that would predict difficult airway management. The Mallampati score (MS) has been shown to be useful in the preoperative assessment of patients being intubated in the operating room. Objective: We sought to define the feasibility of this assessment in the Emergency Department. Methods: A prospective, observational study was performed on all patients being intubated at a university Level I trauma center over a period of 6 months. We recorded and calculated the proportion of patients who were successfully assessed using the MS. Reasons given by individual intubators for failure to assess were recorded. We also tracked patient characteristics between groups and complication rates. Results: Of 328 patients, 32 (10%) were excluded due to incomplete data. Among the remaining 296, 58% were intubated for non-trauma indications, 70% were male, and the mean age was 45.9 years. Only 76 of 296 (26%) (95% confidence interval 21-31%) were able to have the MS performed. Lack of patient cooperation and clinical instability were listed as factors that precluded evaluation in patients whose assessment was unsuccessful. The frequency of procedure-related minor events did not differ significantly between the assessed and non-assessed groups. Major events included two cricothyrotomies in the non-assessed group. Conclusions: We were unable to perform a Mallampati assessment in three-quarters of our patients requiring emergency intubation. These findings call into question the feasibility of the standard Mallampati assessment in the practice of Emergency Medicine. (C) 2010 Elsevier Inc.