Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation—a cluster randomized trial with 64,273 participants
Open accessAbstract
Background Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI with usual airway assessment. Methods From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible optic scope) were excluded from the primary analysis. Primary outcomes were the proportions of unanticipated difficult and unanticipated easy intubation. Results A total of 26 departments (15 SARI and 11 Non-SARI) and 64 273 participants were included. In the primary analyses 29 209 SARI and 30 305 Non-SARI participants were included.In SARI departments 2.4% (696) of the participants had an unanticipated difficult intubation vs 2.4% (723) in Non-SARI departments. Odds ratio (OR) adjusted for design variables was 1.03 (95% CI: 0.77-1.38). The proportion of unanticipated easy intubation wa…
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90% of difficult intubations are unanticipated.
“with 90% of difficult intubations unanticipated”
From Airway Management in Trauma (2018) · cites this paper as [19]
Anatomic markers are in general poor predictors of difficulty with airway management.
“Anatomic markers are in general poor predictors of difficulty with airway management”
From Airway Management in Trauma (2018) · cites this paper as [19]
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Nørskov, A. K., Wetterslev, J., Rosenstock, C. V., Afshari, A., Astrup, G., Jakobsen, J. C., Thomsen, J. L., Bøttger, M., Ellekvist, M., Schousboe, B. M. B., Horn, A., Jørgensen, B. G., Lorentzen, K., Madsen, M. H., Knudsen, J. S., Thisted, B. K., Estrup, S., Mieritz, H. B., Klesse, T., Martinussen, H. J., Vedel, A. G., Maaløe, R., Bøsling, K. B., Kirkegaard, P. R. C., Ibáñez, C. R., Aleksandraviciute, G., Hansen, L. S., Mantoni, T., & Lundstrøm, L. H.
- Affiliations
- Copenhagen University Hospital (DK)
- Aarhus University Hospital (DK)
- Herlev Hospital (DK)
- Frederiksberg Hospital (DK)
- Glostrup Hospital (DK)
- Kolding Hospital (DK)
- Sygehus Sønderjylland (DK)
- Bispebjerg Hospital (DK)
- Roskilde Sygehus (DK)
- Regionshospital Nordjylland (DK)
- Vejle Sygehus (DK)
- Corresponding author
- Nørskov, A.K.
- ORCID
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 116
- Issue
- 5
- Pages
- 680-689
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W2340057065
- Cited by
- 78
- References
- 5
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 9 · 2023: 8 · 2022: 6 · 2021: 9 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 12 · 2016: 5
- FWCI
- 11.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Scopus (Elsevier) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Funders
- TRYG foundation; Nordsjællands Hospitals research council; The National Research Council of Denmark; The Capital Regions funds for research; Dansk Selskab for Anæstesiologi og Intensiv Medicins fund
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
- Keywords
- difficult intubation, preoperative airway assessment, anesthesiology department
- MeSH terms
- Adult, Aged, Double-Blind Method, Female, Humans, Intubation, Intratracheal, Male, Middle Aged, Preoperative Care, Prognosis, Risk Factors, Cluster Analysis, Treatment Failure, Risk Assessment, Airway Management
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