A combined rapid clinical and lung ultrasound score for predicting bronchiolitis severity

Abstract

Introduction Lung ultrasound (LUS) has demonstrated a good correlation with clinical severity scores in bronchiolitis but should be combined with clinical data to achieve the best results. The aim of the study is to create a quick and reliable clinical-ultrasound score to predict the risk of paediatric intensive care (Picu) admission as soon as the patient enters the emergency department (ED). Methods A retrospective study conducted at two paediatric EDs. The lung was divided into six zones and scanned with ultrasound; every zone received a score. Clinical data were obtained. For the outcomes “PICU admission” and “CPAP support”, a multivariate analysis was conducted and the significant factors resulting were used to create a 3-item score to predict PICU admission. Area under the receiver-operating curve (AUC) for specificity and sensibility of the score was obtained. Results Seventy-four patients were enrolled; 34% were admitted to PICU. Thirty-one percent were treated with CPAP. For the outcome “PICU admission”, multivariate analysis demonstrated the presence of wheezing and reduced oral intake to be significant together with ultrasound involvement of the right posterior upper zone and left posterior basal zone. For the outcome “CPAP support”, same clinical factors plus involvement of the right posterior upper zone were significant. A 3-item score (1: presence of wheezing; 2: reduced oral intake; 3: LUS involvement of right posterior upper zone) for prediction of PICU admission was created which presents an AUC of 0.8249. Conclusions We were able to create a simple and quick score to predict the need for PICU admission in bronchiolitis.

Prognostic Value of the Area of Lung Involved in Severe and Non-Severe Bronchiolitis: An Observational, Ultrasound-Based Study

“…Upper lobes’ greater involvement in more severe cases of bronchiolitis compared to that of the lower lobes is not a new concept. We previously described a population of patients with bronchiolitis studied with lung ultrasound and proposed a combined clinical–ultrasonographic rapid score for detection of severe cases: in this model, the single lung zone most involved in patients then admitted to PICU and requiring ventilation was the Right Posterior Superior Lobe [ 14 ]. Our present study reinforces that finding in a bigger sample of patients and extends it to other superior lung areas.…”

“…This is an important gap in the field of LUS since it is well established that LUS is a clinical tool and should always be interpreted in combination with clinical findings and clinical suspicion [ 12 , 13 ]. In a previous preliminary report, we tested in a smaller cohort a clinical–ultrasound combined score based on a minimum number of clinical and ultrasound finding, showing that wheezing, difficulty in feeding and superior lobe atelectasis were associated with higher risk of PICU admission and need for ventilation [ 14 ]. This greater involvement of upper lung areas in severe cases prompted us to investigate in deeper detail the regional variations between lung areas during severe and non-severe bronchiolitis.…”

Lung Ultrasound: A Useful Prognostic Tool in the Management of Bronchiolitis in the Emergency Department

“…In other words, incorporating lung ultrasound in the assessment of patients with bronchiolitis could enhance their evaluation and increase confidence in safely discharging patients who are considered to be at a lower risk. The early identification of high-risk patients would significantly contribute to improved hospital management, facilitate decision making regarding patient admission, and allow for the timely and accurate administration of respiratory supportive treatment [20,21].…”

“…Point-of-Care Ultrasound (POCUS) is increasingly being used for diagnostic purposes in a variety of healthcare settings due to its rapidity, portability, repeatability, and nonionising properties. Specifically, lung ultrasound (LUS) is proving to be a valuable tool for the objective assessment of respiratory disease in adults, children, and neonates [17,19,20]. Although it is considered less convenient than radiology due to the time required to perform it and the need for a learning curve, this technique is, in fact, a relatively simple and easy-to-learn procedure, with a median time to perform and interpret lung ultrasound findings of only 6 min [16].…”