Predictive values of the modified Mallampati test, upper lip bite test, thyromental distance and ratio of height to thyromental distance to predict difficult laryngoscopy in pediatric elective surgical patients 5-12 years old at selected Addis Ababa governmental hospitals, Ethiopia: A multicenter cross-sectional study.

Background: Maintaining patent airways is vital in pediatric anesthetic management. Failure to manage and anticipate difficult laryngoscopy preoperatively is the leading cause of morbidity and mortality. Data on the predictive values of screening parameters in predicting difficult laryngoscopy (DL) are limited in children. Therefore, this study aimed to assess the predictive value of the modified Mallampati test (MMT), upper lip bite test (ULBT), thyromental distance (TMD), and ratio of height to thyromental distance (RHTMD) in predicting DL in children aged 5-12 years at selected Addis Ababa governmental hospitals in Ethiopia. Methods: : A multicenter cross-sectional study was conducted on 141 elective pediatric surgical patients aged 5 to 12 years selected using a systematic random sampling technique from December 1, 2021, to April 30, 2022. Data were collected using structured questionnaires. The collected data were entered and analysed by SPSS version 26. Fisher’s exact test and receiver operating characteristic curve analysis were used to compare the accuracy of MMC, ULBT, TMD, and RHTMD against difficult laryngoscopy. A P value <0.05 was considered statistically significant. Results: : The magnitude of difficult laryngoscopy was 15.6%. MMT has the highest sensitivity (86.4%), specificity (91.6%), and negative predictive value (NPV) (97.3%) compared to other tests. The ULBT also has a high sensitivity (72.7%), specificity (84%), and NPV (94.3%) with comparable diagnostic accuracy (90.8%) with the MMT (P<0.05). The sensitivity, specificity, positive predictive value (PPV), NPV, and accuracy of TMD were 63.6%, 95.8%, 73.7%, 93.4%, and 82.2%, respectively. The RHTMD has the lowest specificity (63.6%), PPV (22.5%), NPV (91.4%), and accuracy (56.7%) in predicting difficult laryngoscopy. Conclusion: The MMT and ULBT are good screening tests, followed by the TMD in predicting DL, while the RHTMD was the least accurate predictor. Because no single test has 100% predictive value, a combination of screening tests is advised in pediatrics for predicting difficult laryngoscopy.