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Anesthesiologist, Parsteb Pajouheshyar Medical Sciences Research Institute, Tehran, Iran, Payam_eghtesadi{at}yahoo.com (Eghtesadi-Araghi) Assistant Professor of Anesthesiology, Department of Cardiac Surgery, Dr. Shariati Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran (Marashi)
To the Editor:
We read with interest the Eberhart et al. (1) study. The authors evaluated the Upper Lip Bite test with respect to applicability, interobserver reliability, and discriminating power and compared it with the Mallampati score. They demonstrated that the Upper Lip Bite test could not be applied in 12% of all patients with better interobserver reliability and poorer discriminating power compared with the Mallampati test. To achieve an optimal level of comparison between the study by Khan et al. (2) and this study, the authors used identical definitions and gradings of the papers describing the two predictive tests, but we think there may be problems in simulations.
As the authors described in the Methods section, with the purpose of testing the clinical usefulness of the Upper-Lip-Bite test, there were no exclusion criteria (1). Also, all 318 patients excluded from the study (162 edentulous, 15 could not perform Upper Lip Bite test or Mallampati test, 33 were not intubated, and in 108 intubation was performed by an ineligible performer) (1) were not synchronized with exclusion criteria mentioned in the Khan et al. (2) study. In the original study those unable to open the mouth, with laryngeal masses, or with limitation of cervical movements were excluded (1). Patients with oropharyngeal pathologies or whose neck mobility was severely limited by cervical spine disease or radiation-induced scarring must also be excluded. Along with the lower clinical experience of anesthesiologists performing the endotracheal intubation (1), these incongruities may affect the results of this study. We think that the results are not only incomparable with original study but are also biased.
These results may also describe the frequent incidence of difficult laryngoscopy resulting in higher false-negative ratings and lower sensitivity (1) reported in this study and higher accuracy of prediction in the original report. There also may be an unintentional erratum in the power analysis estimation that "15% change in AUC" might be "(e.g., from 50% to 65%)" and not "(50% to 0.65%)".
References
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