• Jong Ho Kim, Haewon Kim, Ji Su Jang, Sung Mi Hwang, So Young Lim, Jae Jun Lee, and Young Suk Kwon.
• Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, South Korea.
• BMC Anesthesiol. 2021 Apr 21; 21 (1): 125.

BackgroundPredicting difficult airway is challengeable in patients with limited airway evaluation. The aim of this study is to develop and validate a model that predicts difficult laryngoscopy by machine learning of neck circumference and thyromental height as predictors that can be used even for patients with limited airway evaluation.MethodsVariables for prediction of difficulty laryngoscopy included age, sex, height, weight, body mass index, neck circumference, and thyromental distance. Difficult laryngoscopy was defined as Grade 3 and 4 by the Cormack-Lehane classification. The preanesthesia and anesthesia data of 1677 patients who had undergone general anesthesia at a single center were collected. The data set was randomly stratified into a training set (80%) and a test set (20%), with equal distribution of difficulty laryngoscopy. The training data sets were trained with five algorithms (logistic regression, multilayer perceptron, random forest, extreme gradient boosting, and light gradient boosting machine). The prediction models were validated through a test set.ResultsThe model's performance using random forest was best (area under receiver operating characteristic curve = 0.79 [95% confidence interval: 0.72-0.86], area under precision-recall curve = 0.32 [95% confidence interval: 0.27-0.37]).ConclusionsMachine learning can predict difficult laryngoscopy through a combination of several predictors including neck circumference and thyromental height. The performance of the model can be improved with more data, a new variable and combination of models.

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