Introduction

The GILLS score was introduced to help predict the success of tongue-lip adhesion (TLA) to treat severe airway compromise in Robin sequence patients.  The GILLS score considers five factors, each of which is assigned a point: Gastric Esophageal Reflux Disease (GERD), pre-operative Intubation, Late surgical intervention (age >14 days), Low birth weight (<2500g) and Syndromic diagnosis. In deriving the test using a linear regression analysis in 51 patients, we found that a score of 2 or less predicted a successful outcome after TLA 100% of the time. The GILLS scoring system, however, has yet to be validated in a novel cohort of Robin patients.

Purpose

The purpose of this study is to test the validity of the GILLS score in predicting success and failure of TLA in patients with Robin sequence.

Materials and Methods

Patients were included if they had Robin sequence, were treated with a TLA for severe airway compromise, and underwent the procedure subsequent to development of the GILLS scoring system (not included in original GILLS analysis). These patients were prospectively studied for the presence of the five factors which make up the GILLS score: GERD, preoperative intubation, age at surgical intervention, birth weight, and presence of a syndromic diagnosis.    

Results

Sixteen patients met the inclusion criteria.  Overall, tongue-lip adhesion successfully managed airway compromise in 14/16 (88%) of Robin patients. There were thirteen patients who had a GILLS score of 2 or less, and none of them required further intervention. Three patients had a GILLS score of 3 or more. Of these, two failed tongue-lip adhesion and required a subsequent tracheostomy. The remaining patient, who had a GILLS score of 5, required no further intervention. 

Overall, the GILLS score (considering a score of 2 or less as a positive test) had a sensitivity of 93%; specificity of 100%; positive predictive value of 87%; and negative predictive value of 67%.

Conclusion

The GILLS score is a tool that can be successfully used to predict the outcome for TLA.  Overall, TLA is highly successful in managing Robin patients with severe airway compromise, especially in those with a GILLS score of 2 or less. In this group, TLA is the procedure of choice. In those with a higher GILLS score, one should consider other methods of airway management.