PREOPERATIVE AIRWAY ASSESSMENT SCORES AND THEIR PREDICTIVE VALUE FOR DIFFICULT INTUBATION: A PROSPECTIVE OBSERVATIONAL STUDY AT CLEARMEDI PARIDHI HOSPITAL, GWALIOR

Background: Unanticipated difficult intubation remains a leading cause of anaesthesia-related morbidity and mortality.Preoperative airway assessment scores aim to stratify risk and guide preparation, yet their predictive accuracy varies acrosspopulations and scoring systems. The objective is to evaluate the predictive value of preoperative airway assessment scoresModified Mallampati Test (MMT), Thyromental Distance (TMD), Sternomental Distance (SMD), Upper Lip Bite Test(ULBT), Wilson's Score, and Intubation Prediction Score (IPS) for difficult intubation in patients undergoing generalanaesthesia with endotracheal intubation. Materials and Methods: This prospective observational study was conducted atClearmedi Paridhi Hospital, Gwalior, over 12 months (May 2025–April 2026). One hundred patients aged 18–70 years, ASAI–II, scheduled for elective surgery requiring endotracheal intubation were enrolled. Preoperative airway assessment wasperformed using MMT, TMD, SMD, ULBT, Wilson's Score, and IPS. Difficulty of intubation was assessed using theIntubation Difficulty Scale (IDS); IDS >5 defined difficult intubation. Sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: The incidence of difficultintubation was 12% (12/100). MMT showed sensitivity 75.0%, specificity 78.4%, PPV 32.1%, NPV 95.8%. TMDdemonstrated sensitivity 66.7%, specificity 86.4%, PPV 40.0%, NPV 95.0%. ULBT exhibited sensitivity 58.3%, specificity90.9%, PPV 46.7%, NPV 94.1%. Wilson's Score showed sensitivity 33.3%, specificity 93.2%, PPV 40.0%, NPV 91.1%, andaccuracy 86.0%. IPS demonstrated the highest sensitivity (75.0%), specificity (96.6%), PPV (75.0%), NPV (96.6%), andoverall accuracy (94.0%). The combination of MMT + TMD + ULBT improved sensitivity to 83.3%. Conclusion: IPSoutperformed individual bedside tests and Wilson's Score in predicting difficult intubation. A multimodal approachcombining MMT, TMD, and ULBT enhances predictive sensitivity. Routine incorporation of IPS into preoperativeassessment may improve patient safety.