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Is Mallampati Scoring Useless?

September 24, 2019

Written by Vivian Lei

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The Mallampati score has not been shown to be adequately sensitive for determining difficult laryngoscopy, intubation, or bag-valve-mask ventilation in ED patients. Moreover, it is unreliable and frequently unfeasible in certain patient populations. 

Why does this matter?
Obtaining a Mallampati score has become a routine part of airway screening in both general anesthesia as well as procedural sedation. However, there is no compelling evidence to support its test characteristics in predicting difficult airway management and may even distract from more emergent aspects of airway evaluation in the ED.

Is Mallampati scoring a waste of time?
This was a literature review of the Mallampati score and its relevance in ED airway management and procedural sedation. Based on the authors’ review, they concluded:

  • The Mallampati score has poor sensitivity in predicting difficult laryngoscopy, intubation, or bag-valve-mask ventilation. In the largest Cochrane meta-analysis, the aggregate sensitivity for Mallampati scoring and difficult laryngoscopy was 53%; for predicting difficult intubation, aggregate sensitivity was 51%; and for predicting difficult bag-valve-mask ventilation, aggregate sensitivity was 17%.

  • There is not enough data regarding an association between the Mallampati score and procedural sedation-related adverse events.

  • Interrater reliability of the Mallampati score is poor and falls between 42% and 89% (k between 0.1 and 0.64) in studies of preoperative and dental patients.

  • Evaluating the Mallampati score is often not feasible in critically ill patients and children due to inadequate patient cooperation. Remember, Mallampati scoring is performed with the patient sitting upright, mouth opened wide, tongue protruding, and remaining quiet.

Overall, authors found that the Mallampati score does not add any meaningful information to a standard ED airway evaluation for procedural sedation. The upper lip bite test might be a better choice.

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation? Ann Emerg Med. 2019 Aug;74(2):251-259. doi: 10.1016/j.annemergmed.2018.12.021. Epub 2019 Feb 16.

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Reviewed by Clay Smith

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