DIAGNOSTIC ACCURACY OF UPPER LIP BITE TEST AND PRAYER SIGN FOR THE DETECTION OF DIFFICULT INTUBATION BY TAKING CORMACK AND LEHANE GRADING AS GOLD STANDARD IN DIABETIC PATIENTS UNDERGOING ELECTIVE SURGERY
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Keywords
Airway management, Upper Lip Bite Test, Prayer Sign, Difficult intubation, Cormack and Lehane
Abstract
The Upper Lip Bite Test (ULBT) is a commonly used bedside assessment to predict difficult laryngoscopic intubation, yet its diagnostic accuracy remains debated. Various preoperative tests aim to identify difficult airways to reduce morbidity and mortality from unanticipated difficult intubations.
Objective: To compare the diagnostic accuracy of the Upper Lip Bite Test and Prayer Sign against the Cormack and Lehane grading system as the gold standard for detecting difficult intubation in diabetic patients undergoing elective surgery at a tertiary care hospital in Karachi.
Study Design: Cross-sectional study.
Materials and Methods: A total of 252 diabetic patients aged 30 to 80 years scheduled for elective surgery were assessed preoperatively using ULBT and Prayer Sign tests. Difficult intubation was confirmed intraoperatively using Cormack and Lehane grading. Sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of both tests were calculated using SPSS version 19.
Results: The mean age was 51.9 ± 14.5 years, with 57% over 48 years. The mean diabetes duration was 5.8 ± 2.6 years, with 65.5% male. Difficult intubation (Cormack and Lehane grades III/IV) was observed in 77% of cases. ULBT demonstrated higher sensitivity (93.3% vs. 82.99%) and negative predictive value (78.33% vs. 59.76%), while Prayer Sign showed slightly better specificity (84.48% vs. 81.03%) and similar positive predictive values (94.71% vs. 94.27%). Overall accuracy favored ULBT (90.48% vs. 83.33%).
Conclusion: Both ULBT and Prayer Sign are effective for predicting difficult intubation in diabetic patients. Given its ease of use and higher accuracy, ULBT is recommended as a primary bedside test, alone or in combination with other assessments.
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Sajjad Ahmed khan
MBBS, FCPS 1/PGR (Anesthesiology), Department of Anesthesiology, Dow University Hospital Karachi
Noor us Saba
MBBS, FCPS, Consultant Anaesthetist Department of Anesthesiology, Dow University Hospital Karachi
Muneeba Arshad
MBBS, FCPS, Assistant Professor Anaesthesiology, Department of Anaesthesiology, Dow International Medical College, Dow University Hospital Karachi, Pakistan.
Syed Shayan Ahmed
MBBS, FCPS, (Anesthesiology), Senior Medical Officer, Dow University Hospital Karachi,