{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:42:47Z","timestamp":1786725767875,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Background and Objective:<\/jats:title>\n Predicting difficult endotracheal intubation in the pediatric population remains a challenge for anesthesiologists as limited cooperation, unique anatomical conditions, congenital abnormalities, and lack of appropriately sized airway equipment pose additional challenges. Acromioaxillo suprasternal notch index (AASI) has emerged as a promising tool requiring minimal patient cooperation, making it suitable for pediatric use. The objective of the study is to evaluate the effectiveness of AASI in predicting difficult laryngoscopy in children aged 2\u201310 years undergoing general anesthesia with endotracheal intubation.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n The cross-sectional observational study was conducted in children (\n N<\/jats:italic>\n = 55) aged 2\u201310 years scheduled for surgery requiring general anesthesia. Preoperative measurements including age, weight, height, Cormack-Lehane grade, application of laryngeal pressure, the number of intubation attempts, and AASI scores, were recorded. The sensitivity, specificity, and overall accuracy of AASI in predicting difficult tracheal intubation were assessed.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The mean age of the children was 5.92 \u00b1 2.88 years, with the majority being girls (70.91%). Increased AASI score, number of intubation attempts, and increased laryngeal pressure were significantly associated with difficult laryngoscopy. A moderate positive correlation was found between AASI and the Cormack-Lehane score (\n r<\/jats:italic>\n = 0.5313;\n P<\/jats:italic>\n < 0.001). We observed that sensitivity, specificity, and area under curve the ROC curve for AASI (cutoff of >0.51) were 66.67%, 85.29%, and 0.7787 respectively. Logistic regression analysis revealed AASI as a significant predictor of difficult laryngoscopy (\n P<\/jats:italic>\n = 0.0026).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n AASI is a good predictor of difficult laryngoscopy in children aged 2-10 years. It can serve as a valuable preoperative screening tool for identifying high-risk patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jpbs.jpbs_1407_25","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:00:09Z","timestamp":1769158809000},"page":"S126-S129","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Acromio-Axillo-Suprasternal Notch Index as a Predictor of Difficult Laryngoscopy in Pediatric Patients: An Observational Study"],"prefix":"10.4103","volume":"18","author":[{"given":"Purvashree Vijay","family":"Deshmukh","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, KAHER\u2019s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishabh G.","family":"Mankale","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, KAHER\u2019s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandana Abhijit","family":"Gogate","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, KAHER\u2019s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"R2-20260310","doi-asserted-by":"crossref","first-page":"244","DOI":"10.4097\/kjae.2016.69.3.244","article-title":"Encountering unexpected difficult airway: Relationship with the intubation difficulty scale","volume":"69","author":"Koh","year":"2016","journal-title":"Korean J Anesthesiol"},{"key":"R3-20260310","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.bja.2017.10.021","article-title":"Guidelines for the management of tracheal intubation in critically ill adults","volume":"120","author":"Higgs","year":"2018","journal-title":"Br J Anaesth"},{"key":"R4-20260310","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/TheIAForum.TheIAForum_74_19","article-title":"A comparative study of acromio-axillo-suprasternal notch index with upper lip bite test and modified Mallampati score to predict difficult laryngoscopy","volume":"21","author":"Sunkam","year":"2020","journal-title":"Indian Anaesth Forum"},{"key":"R5-20260310","first-page":"744478","article-title":"Recommendations from the Brazilian Society of Anesthesiology (SBA) for difficult airway management in pediatric care","volume":"74","author":"Lima","year":"2024","journal-title":"Braz J Anesthesiol"},{"key":"R6-20260310","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/ALN.0b013e31827773b2","article-title":"Practice guidelines for management of the difficult airway: An updated report by the American society of anesthesiologists task force on management of the difficult airway","volume":"118","author":"Apfelbaum","year":"2013","journal-title":"Anesthesiology"},{"key":"R7-20260310","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/anae.14608","article-title":"Bedside tests for predicting difficult airways: An abridged Cochrane diagnostic test accuracy systematic review","volume":"74","author":"Roth","year":"2019","journal-title":"Anaesthesia"},{"key":"R8-20260310","doi-asserted-by":"crossref","first-page":"945","DOI":"10.4103\/ija.IJA_480_18","article-title":"An observational prospective study of performance of acromioaxillosuprasternal notch index in predicting difficult visualisation of the larynx","volume":"62","author":"Rajkhowa","year":"2018","journal-title":"Indian J Anaesth"},{"key":"R9-20260310","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/abr.abr_228_19","article-title":"How to predict difficult tracheal intubation: The application of acromio-axillo-suprasternal notch index","volume":"9","author":"Nasr-Esfahani","year":"2020","journal-title":"Adv Biomed Res"},{"key":"R10-20260310","doi-asserted-by":"crossref","first-page":"20503121211052436","DOI":"10.1177\/20503121211052436","article-title":"The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia: An observational study","volume":"9","author":"Amaha","year":"2021","journal-title":"SAGE Open Med"},{"key":"R11-20260310","doi-asserted-by":"crossref","first-page":"e118931","DOI":"10.5812\/aapm.118931","article-title":"Comparative evaluation of difficult intubation predictors in children under two years of ages","volume":"11","author":"Shahhosseini","year":"2021","journal-title":"Anesth Pain Med"},{"key":"R12-20260310","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S2213-2600(15)00508-1","article-title":"Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: A prospective cohort analysis","volume":"4","author":"Fiadjoe","year":"2016","journal-title":"Lancet Respir Med"},{"key":"R13-20260310","doi-asserted-by":"crossref","first-page":"69","DOI":"10.4103\/bjoa.bjoa_154_21","article-title":"Acromioaxillo suprasternal notch index as new screening test to predict difficult laryngoscopy in pediatric population: A case series","volume":"6","author":"Senapathi","year":"2022","journal-title":"Bali J Anesth"},{"key":"R14-20260310","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.aat.2013.12.001","article-title":"Comparison of acromioaxillosuprasternal notch index (a new test) with modified Mallampati test in predicting difficult visualization of larynx","volume":"51","author":"Kamranmanesh","year":"2013","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"R15-20260310","first-page":"66","article-title":"Comparison of the performance of acromioaxillosuprasternal notch index with old method of anatomical measurement of head and neck in predicting laryngoscopy forecasting problems in pediatrics surgical procedures requiring tracheal intubation under general anesthesia","volume":"37","author":"Safavi","year":"2019","journal-title":"J Isfahan Med Sch"}],"container-title":["Journal of Pharmacy and Bioallied Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1407_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:25:20Z","timestamp":1786724720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1407_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":14,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jpbs.jpbs_1407_25","relation":{},"ISSN":["0976-4879","0975-7406"],"issn-type":[{"value":"0976-4879","type":"print"},{"value":"0975-7406","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"assertion":[{"value":"2025-08-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}