Interdisciplinary Evaluation of Pediatric Airway Assessment Using Brodsky and Mallampati Classifications.

Purpose: To assess the interrater agreement and reliability of pediatric airway assessments using the Brodsky and Mallampati classifications among pediatric dentistry residents, pediatric dentistry faculty and anesthesiologists. This study also aimed to determine the consistency of sedation decisions and the impact of clinical experience on classification reliability.

Methods

A cross-sectional study was conducted with 50 participants who evaluated 17 pediatric airway videos, grading tonsillar obstruction using the Brodsky scale and oropharyngeal visibility using the Mallampati classification. Sedation decisions were recorded as binary outcomes. Assessments were completed twice, seven days apart, for intra-rater reliability. Interrater agreement was measured using Kendall's W and Fleiss' Kappa, while reliability was assessed using the intraclass correlation coefficient (ICC). Statistical differences between groups were analyzed using Kruskal-Wallis and Wilcoxon rank-sum tests.

Results

The Brodsky scale demonstrated moderate to good interrater reliability, with anesthesiology faculty showing the highest agreement (ICC=0.627 to 0.612), followed by the dental faculty (ICC=0.654). Residents maintained moderate reliability (ICC=0.578 to 0.536). The Mallampati classification showed lower reliability, with anesthesiology faculty declining from moderate agreement (ICC=0.365) to poor agreement (ICC=0.209) between surveys. Sedation decisions had moderate agreement, with Fleiss' Kappa values of 0.467 for anesthesiology faculty, 0.407 for dental faculty and 0.371 for residents.

Conclusions

The Brodsky scale was more reliable than the Mallampati classification, especially among experienced clinicians. The Mallampati classification showed greater variability. Structured training and clear protocols are necessary to improve airway assessment consistency and sedation safety.