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El-Ganzouri Risk Index (EGRI) for difficult airway

Multivariate bedside score predicting difficult tracheal intubation.

El-Ganzouri Risk Index (EGRI) for difficult airway
Mouth opening (interincisor gap)
Thyromental distance
Modified Mallampati class
Neck movement (range of flexion/extension)
Ability to prognath (protrude lower jaw past upper incisors)
Body weight
History of difficult intubation
Result0 points

A score below 4 is associated with a low likelihood of difficult intubation.

Difficult intubation threshold
>=4 points

When to use

  • Structured preoperative bedside prediction of difficult direct laryngoscopy/intubation, combining seven independent airway predictors.

Formula

Sum of points across 7 items (range 0-12): mouth opening, thyromental distance, Mallampati class, neck movement, prognathism, weight, history of difficult intubation.

Pearls and pitfalls

  • Developed and validated for direct laryngoscopy; predictive performance with video laryngoscopy is less established.
  • No single component should override overall clinical judgement of the airway.

References

  1. el-Ganzouri AR, et al. Anesth Analg. 1996;82(6):1197-1204.