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Comparison of severity scales for acute bronchiolitis in real clinical practice

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Abstract

Several clinical scales have been developed to assess the severity of bronchiolitis as well as the probability of needing in-hospital care. A recent systematic review of 32 validated clinical scores for bronchiolitis concluded that 6 of them (Wood-Downes, M-WCAS, Respiratory Severity Score, Respiratory Clinical Score, Respiratory Score and Bronchiolitis risk of admission score) were the best ones regarding reliability, sensitivity, validity, and usability. However, to the best of our knowledge, no study has compared all of them in a clinical scenario. Also, after this review, three more scales were published: BROSJOD, Tal modified, and one score developed by PERN. Our main aim was to compare the ability of different clinical scales for bronchiolitis to predict any relevant outcome. A prospective observational study was conducted that included patients of up to 12 months old attended to, due to bronchiolitis, in the paediatric Emergency Department of a secondary university hospital from October 2019 to January 2022. For each patient, the attending clinician filled in a form with the items of the scales, decomposed, in order to prevent the clinician from knowing the score of each scale. Then, the patient was managed according to the protocol of our Emergency Department. A phone call was made to each patient in order to check whether the patient ended up being admitted in the next 48 h. In the case of those that were impossible to contact by phone, the clinical history was reviewed. For the purpose of the study, any of the following were considered to be a relevant outcome: admission to ward and need for supplementary oxygen, non-invasive ventilation (NIV) or intravenous fluids, and admission to the paediatric intensive care unit (PICU) within the next 48 h or death. For the aim of the study, the area under the curve (AUC) and the odds ratio (OR) for a relevant outcome were calculated in each scale. Also, the best cut-off point was estimated according to the Youden index, and its sensitivity (Sn) and specificity (Sp) for a relevant outcome were calculated. We included 265 patients (52.1% male) with a median age of 5.3 months (P25-P75 2.6–7.4). Among them, 46 (17.4%) had some kind of relevant outcome. AUC for prediction of a relevant outcome ranged from 0.705 (Respiratory Score) to 0.786 (BRAS), although no scale performed significantly better than others. A score ≤ 2 in the PERN scale showed a sensitivity of 91.3% (CI95% 79.7–96.6) for a relevant outcome, with only 4 misdiagnosed patients (only 2 of them needed NIV).

  Conclusions: There were no differences in the performance of the nine scales to predict relevant outcomes in patients with bronchiolitis. However, the PERN scale might be more useful to select patients at low risk of a severe outcome.

What is Known:

• Several clinical scales are used to assess the severity of bronchiolitis. Nevertheless, none of them seems to be better than others.

What is New:

• This is the first study comparing different bronchiolitis scales in a real clinical scenario. None of the nine scales compared performed better than the other. However, the PERN scale might be more useful to select patients at low risk of relevant outcomes.

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Availability of data and material

All data of the study are at disposal of the editor if needed.

Abbreviations

AUC:

Area under the curve

BRAS:

Bronchiolitis Risk of Admission Score

ED :

Emergency department

P25-p75:

First and third quartiles

M-WCAS:

Modified Wood’s Clinical Asthma Score

NIV:

Non-invasive ventilation

PEM:

Paediatric Emergency Medicine

PERN:

Pediatric Emergency Research Network

PICU:

Paediatric intensive care unit

RCS:

Respiratory Clinical Score

RSS:

Respiratory Severity Score

Sn:

Sensitivity

Sp:

Specificity

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Acknowledgements

We acknowledge all the members of the paediatric emergency department for their substantial contribution to the development of the study.

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Authors and Affiliations

  1. Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain

    Elena Granda, Mario Urbano, Pilar Andrés, Marina Corchete & Alfredo Cano

  2. Pediatric Emergency Department, Hospital Universitario Río Hortega, Valladolid, Spain

    Roberto Velasco

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  1. Elena Granda
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  4. Marina Corchete
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  5. Alfredo Cano
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Contributions

Elena Granda conceptualized and designed the study, collaborated in data collection, revised multiple drafts of the manuscript, and critically revised the final submitted manuscript. Roberto Velasco designed the study, analysed the data, wrote the initial draft of the manuscript, and approved the final manuscript as submitted. Mario Urbano, Pilar Andrés, Marina Corchete, and Alfredo Cano collaborated in the design of the study and in data collection, revised multiple manuscript drafts, and critically revised the final submitted manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Elena Granda.

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Ethics approval

The study was approved by the Ethics Committee of Valladolid Oeste.

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Written consent from the parents or caregivers was obtained prior to the participation of every included patient.

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Informed consent was obtained prior to the publication of every included patient.

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The authors declare no competing interests.

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Communicated by Piet Leroy.

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Granda, E., Urbano, M., Andrés, P. et al. Comparison of severity scales for acute bronchiolitis in real clinical practice. Eur J Pediatr 182, 1619–1626 (2023). https://doi.org/10.1007/s00431-023-04840-5

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  • DOI: https://doi.org/10.1007/s00431-023-04840-5

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