Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy

Abstract

Background A valid bronchoscopic scoring tool for bronchitis would be useful for clinical and research purposes as currently there are none in children. From 100 digitally recorded flexible bronchoscopies (FB), we related the various macroscopic features to airway neutrophil % to develop a FB‐derived bronchitis score (BScoreexp). We aimed to develop a FB‐derived bronchitis tool. Methods FB recordings for six visualised features: secretions (amount and color) and mucosal appearance (erythema, pallor, ridging, oedema) based on pre‐determined criteria on a pictorial chart were assessed by two physicians independently, blinded to the clinical history. These features were used to obtain various models of BScoreexp that were plotted against bronchoalveolar lavage (BAL) neutrophil % using a receiver operating characteristic (ROC) curve. Inter‐ and intra‐rater agreement (weighted‐kappa, K) were assessed from 30 FBs. Results Using BAL neutrophilia of 20% to define inflammation, the highest area under ROC (aROC) of 0.71, 95%CI 0.61‐0.82 was obtained by the giving three times weightage to secretion amount and color and adding it to erythema and oedema. Inter‐rater K values for secretion amount (K = 0.87, 95%CI 0.73‐1.0) and color (K = 0.86, 95%CI 0.69‐1.0) were excellent. Respective intra‐rater K were 0.95 (0.87‐1.0) and 0.68 (0.47‐0.89). Other inter‐rater K ranged from 0.4 (erythema) to 0.64 (pallor). Conclusion A repeatable FB‐defined bronchitis scoring tool can be derived. However, a prospective study needs to be performed with larger numbers to further evaluate and validate these results.

Development and validation of a bronchoscopically defined bronchitis scoring tool in children

“…Two clinicians (KPE and RJT), who were blinded to the clinical history and laboratory data, reviewed the bronchoscopy video recordings and scored independently according to visual pro forma as previously described in our retrospective study. 15 , and (f) pallor (P). We used our previously validated six-point scale to score the amount of secretions.…”

“…When further examining the correlation between the few best models of bronchitis score and cough symptom, SCORE provided a Our retrospective study 15 participants in the earlier study and/or higher quality data in this present study. Nevertheless, a similar trend was seen in both studies whereby the secretion color has the strongest correlation, followed by secretion amount, mucosal oedema, erythema, ridging and pallor.…”

“…Our previous study obtained an experimental bronchitis score Our group's idea of combining both the airway secretions and mucosal appearance in the development of a bronchitis scoring tool is novel and valid. As in our previous study, 15 the present study cohort was also a heterogeneous cohort which appear to be representative of the "real world" setting that consists of varied patients encountered in clinical practice in evaluating bronchitis.…”

“…In the absence of any bronchoscopy-derived score for bronchitis, we recently reported our retrospective study where we derived a pilot bronchitis scoring system (BScore exp ) relating bronchoscopic quantified scores based on airway mucosal appearance (oedema, ridging, pallor, and erythema) and secretions (amount and color) to airway neutrophilia. 15 In the present study, we examined how the BScore performed in a prospective cohort of 150 children to validate the tool. We hypothesized that a bronchoscopically defined scoring system which depicts bronchitis in children and correlates with airway neutrophils, as a measure of inflammation, can be developed and validated.…”

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

“…An objective or semiobjective scoring system for bronchoscopic visual assessment of airways inflammation would be of potential utility for both clinical diagnosis and research. Thomas et al described such a system after retrospectively reviewing 100 consecutive bronchoscopic digital recordings, and assigning a score for secretion color and amount, and mucosal edema, ridging, erythema and pallor, at each of nine standardized airway locations. This was then assessed against BAL neutrophilia (>20%) as a standard measure for airways inflammation.…”