Evaluation of anatomical and ultrasonographic parameters to predict difficult airway in pediatric patients.

Cohort studyInternational journal of pediatric otorhinolaryngology· Jul 2026

Evaluation of anatomical and ultrasonographic parameters to predict difficult airway in pediatric patients.

Demet Altun, Mert Canbaz, Müşerref Beril Dinçer … Emre Çamcı

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Airway ManagementCohort studyDiagnosisQ2IF 1.6

Ultrasound skin-to-epiglottis distance best predicts difficult intubation in children

Evaluation of anatomical and ultrasonographic parameters to predict difficult airway in pediatric patients.

Demet Altun … Emre Çamcı

International journal of pediatric otorhinolaryngology · Jul 2026 · Q2 in General Medicine

Background

Predicting a difficult airway in pediatric patients remains challenging due to unique anatomical and physiological characteristics.

Purpose

This study aimed to assess the diagnostic performance of anatomical and ultrasonographic parameters in predicting difficult intubation in pediatric patients.

Methods

In this prospective, double-blind observational study, children aged 1-12 years undergoing elective surgery with endotracheal intubation were evaluated.

n = 240 children

Results

an AUROC this close to 1.0 means near-perfect prediction of a difficult airway

S-ED

0.941AUC

S-HD

0.912AUC

HMD

0.898AUC

Mallampati

0.86AUC

More results

Thyromental distance and SMD showed moderate predictive ability.

Combining significant clinical and sonographic parameters improved diagnostic performance, with S-ED + skin-hyoid distance yielding an AUC of 0.961.

More results

Multivariable regression identified S-ED (OR 4.61), skin-hyoid distance (OR 1.76), Mallampati ≥ III, and facial anomalies as independent predictors of difficult intubation.

The final model correctly classified 95.4% of cases.

“

Conclusion · 1 of 3

Ultrasonographic parameters, particularly S-ED and skin-hyoid distance, are highly accurate predictors of difficult intubation in children and outperform traditional clinical tests.

Conclusion · 2 of 3

Combining sonographic with anatomical assessments significantly enhances diagnostic performance.

Conclusion · 3 of 3

Airway ultrasound provides an objective, reproducible, and non-cooperation-dependent tool that can improve preoperative risk stratification in pediatric anesthesia.

Evaluation of anatomical and ultrasonographic parameters to predict difficult airway in pediatric patients.

Evaluation of anatomical and ultrasonographic parameters to predict difficult airway in pediatric patients.

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