Is Airway-Related Pathology the Main Risk Factor for Difficult Intubation in Children Under 6 Years Old?
Galve Navarro, Sandra (Hospital Universitari Vall d'Hebron)
Munar Bauzá, Francisca (Hospital Universitari Vall d'Hebron)
Muro-Castro, Cristina (Hospital Universitari Vall d'Hebron)
García Martínez, Irene (Hospital Universitari Vall d'Hebron)
Manrique, Susana (Hospital Universitari Vall d'Hebron)
Nadal Clanchet, Miriam de (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2025
Resum:	Introduction: - Evaluating pediatric airways is challenging, particularly in identifying those at risk for difficult intubation, which is often linked to craniofacial malformations. Limited cooperation from preschoolers further complicates this evaluation. Objective: - To evaluate the predictive accuracy of the Arné Score in identifying risk factors for difficult intubation in preschool-aged children (under 6 y) and develop a model to prevent difficult laryngoscopy and intubation. Secondary objectives include determining the incidence of difficult intubation and the appropriate age for preanesthetic airway assessments. Methods: - This retrospective observational study analyzed 1385 patients aged 0 to 16 years, all undergoing general anesthesia and tracheal intubation in 2018 at a tertiary hospital in Barcelona. Among them, 708 were under 6 years. Predictive tests included the Arné Score, with difficult intubation defined by Cormack-Lehane scores, intubation attempts, and alternative device use. Logistic regression analyzed predictors with significant odds ratios. Results: - Unrecorded Mallampati test values were common in children under 6 years (99. 04%). Of those without a history, 8. 07% faced intubation difficulties, compared with 50% with a history. Relative risk was 6. 23, and the odds ratio was 11. 46. Among 202 classified with airway difficulties, 82. 67% had no intubation issues. Statistically significant associations highlighted greater risks for those with a difficult intubation history. Conclusions: - Arné Score tests are impractical for children under 6. If no history or airway pathology exists, there's a 95. 14% chance of successful intubation. The history of difficult intubation increases risks more than airway pathology alone.
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Llengua:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Matèria:	Airway-related disease ; Craniofacial malformations ; Logistic regression ; Pediatric intubation ; Predictive factors
Publicat a:	Journal of Craniofacial Surgery, Vol. 36, Num. 8 (2025) , p. 3035-3039, ISSN 1536-3732

DOI: 10.1097/SCS.0000000000011304
PMID: 40172950

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