TRACHY score: a simple and effective guide to management of the airway in head and neck cancer

Our aim was to provide a simple and effective scoring system to guide decision making in management of the airway. We retrospectively reviewed the casenotes of all patients diagnosed with head and neck cancer and who were treated by resection with primary flap reconstruction. Those factors that were significant (p< 0.05) were analysed by logistic regression to establish their weighting. A total of 149 patients were included, 67 of whom (45%) were managed with endotracheal tubes, and 82 with tracheostomy (55%), of which eight were unplanned and late. From this we produced a score based on: T (T staging), R (Reconstruction), A (Anatomy of tumour), C (Coexisting conditions), H (History of previous treatment for head and neck cancer), Y (lateralitY- bilateral neck dissection). A score of 4 gave a sensitivity of 91.4%, a positive predictive value of 90.9%, a specificity of 90.8% and a negative predictive value of 88.2%. We applied this score to the patients, and it gave a mean score of: 2.1 (intubated), 5.7 (primary tracheostomy), and 4.6 (late tracheostomy). This is the largest published study to our knowledge of tracheostomies in head and neck cancer flap reconstructions that presents a scoring system for management of the airway. This scoring system can appropriately predict those patients who do not need tracheostomy and can act as a reliable screening tool in preoperative planning of the airway. It could aid management, and reduce the incidence of postoperative tracheostomies, with the potential that patients could be managed more safely, with reduced morbidity and mortality.