OBJECTIVE: To compare an upper airway obstruction score vs. airway endoscopy to detect moderate or severe airway injury associated with endotracheal intubation in children. METHODS: Prospective study. Airway endoscopy and clinical evaluation were performed after extubation. Airway injuries identified on endoscopy or according to the upper airway obstruction score were classified as minor, moderate or severe. The obstruction score was assessed in terms of sensitivity, specificity, positive and negative predictive values and likelihood ratio to detect moderate or severe injuries. RESULTS: Among 215 patient, endoscopy was normal in 10.2%. Minor lesions were diagnosed in 54.9% of the patients, followed by moderate (24.2%) and severe (10.7%) lesions. In 163 patients with upper airway obstruction, the score classified injuries as minor in 23.3%, moderate in 41.4% and severe in 11.2%. A score >4 had a sensitivity of 73.3% (95% CI: 67.4-79.2) to detect moderate or severe injuries and a specificity of 58.6% (95% CI: 52.0-65.2) to exclude patients without moderate or severe lesions. The positive predictive value of a score >4 was 48.7% (95% CI: 42.0-55.4). In patients with a score <3 the chance of not presenting moderate or severe injuries was 80.4% (95% CI: 75.1-85.7). The probability of a patient with moderate or severe injuries to present a score >4 was 73.3% compared to patients without those injuries (41.4%) (1.8 fold higher). CONCLUSIONS: The score reliably ruled out moderate or severe airway injury in patients with minor upper airway distress. On the other hand, scores >4 presented a low specificity. Clinical evaluation can be useful to rule out patients with minor airway injuries.
Intratracheal intubation; child; newborn; airway obstruction; airway injury; subglottic stenosis
