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Access this article online Does upper lip bite test predict difficult intubation?
Website: www.ijaweb.org
DOI: 10.4103/0019-5049.139038
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Sir,
We read the article by Khan and Arbabi describing
the utility of upper lip bite test (ULBT) in predicting
difficult intubation with great interest.[1] However,
we would like to point out few issues, which need
clarification.
There was no blinded comparison of ULBT (diagnostic
test) with the laryngoscopic view (gold standard).
In its absence, it will lead to bias which will result in
over/under interpretation of the value of diagnostic test.[2]
In this study it could have led to over interpretation of
the post‑test probability (from 5.88% to 37.5%). The
authors have excluded patients with gross anatomical
abnormality. Ideally patients of all the severity (less or
very severe) should be included in a diagnostic study
to get the correct value of the test of interest. Moreover,
there is a mention of matching of the control subjects
with the cases. This is not possible and is never done in
any diagnostic study because both the diagnostic test and
the gold standard are done independently. As a result, no
one is able to differentiate the case from the control. If
one knows the case and the control from the beginning
then it defeats the basic purpose of the study.[2] It would
have been good to mention the likelihood ratios so that
the results can be directly applied to Indian population
too. The advantage of the likelihood ratio is that, it is
independent of the prevalence/pre‑test probability which
varies from one geographical area to another geographical
area.[3] The authors have used the cut off points of
How to cite this article: Sethi P, Gupta N. Does upper lip bite test predict difficult intubation?. Indian J Anaesth 2014;58:509.
Indian Journal of Anaesthesia | Vol. 58 | Issue 4 | Jul-Aug 2014
various predictors as suggested by their respective
originators. It will be great if the authors try to calculate
the new cut‑offs of various predictors (like thyromental
distance, sternomental distance etc.) which will be given
maximum. sensitivity and reasonable specificity. The
new cut‑offs should be compared with the old cut‑offs in
finding out the improvement in the post‑test probability.
Despite these limitations, we congratulate the authors
for generating new evidence in the field of ‘predicting
difficult intubation’ which is not only a common
problem but also an important area of interest both for
intensivists and anaesthesiologists.
Priyanka Sethi, Neeraj Gupta1
Departments of Anaesthesiology and Critical Care and 1Pediatrics, All
India Institute of Medical Sciences, Jodhpur, Rajasthan, India
Address for correspondence:
Dr. Priyanka Sethi,
Department of Anaesthesiology and Critical Care,
All India Institute of Medical Sciences, Jodhpur ‑ 342 005,
Rajasthan, India.
E‑mail: dr.priyanka_sethi@yahoo.co.in
REFERENCES
1. Khan ZH, Arbabi S. Diagnostic value of the upper lip bite
test in predicting difficulty in intubation with head and neck
landmarks obtained from lateral neck X‑ray. Indian J Anaesth
2013;57:381‑6.
2. Akobeng AK. Understanding diagnostic tests1: Sensitivity,
specificity and predictive values. Acta Paediatr 2007;96:338‑41.
3. Akobeng AK. Understanding diagnostic tests 2: Likelihood
ratios, pre‑ and post‑test probabilities and their use in clinical
practice. Acta Paediatr 2007;96:487‑91.
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