Need for validated severity score in the assessment of bronchiolitis

Bronchiolitis is a major cause of illness and hospitalisation in infants. Several bronchiolitis scores that are currently used for patient assessment and research purposes lack validation and reliability. A systematic review demonstrated the need for a new, validated severity score.

Bronchiolitis is the most common cause of hospitalisation in children under 2 years of age. However, most infants with bronchiolitis are not hospitalised. In the United Kingdom, 1 to 3% of infants are hospitalised with bronchiolitis, of which around 10% need critical care. Clinical conditions can change quickly, particularly when patients suffer from apnoea. A severity score for bronchiolitis can be helpful to aid clinical decision making as well as an outcome measure for research studies.

Mr William Bedson (University of Liverpool, UK) and colleagues conducted a systematic review in which they aimed to identify new or modified severity scores used for the assessment of bronchiolitis [1]. The secondary aim was to evaluate items commonly used within these scores, followed by the tertiary aim to assess validity and reliability data for these scores.

The systematic review protocol was PROSPERO registered (CRD42020218816). MEDLINE, CINAHL, PubMed, Embase databases were searched using relevant terms. Titles, abstracts, and full texts were screened by two reviewers using predetermined inclusion and exclusion criteria: all types of studies except systematic reviews, children aged <2 years with bronchiolitis, and all languages and years of publications. Data extraction included study characteristics, items within score, and any associated validity and reliability data.

In total, 52 scores were identified, reported between 1973–2019, including 30 original and 22 modified scores. Most scores were administered in emergency departments (n=27). Authors assessed 51 different items and grouped them into 9 domains. Most common items were respiratory rate (88%), wheeze (83%), muscle retractions (71%), nasal flaring (42%), and oxygen saturation (32%). The previously mentioned items were reviewed in more depth. Validity and reliability data was available in 15 studies.

There are many scores currently cited for use in bronchiolitis assessment, which most commonly involve assessments of respiratory rates, wheeze, and retractions. Most scores were poorly validated. Mr Bedson ended his presentation sharing that there is an urgent need for development of a well validated severity score for bronchiolitis.

1. Bedson W, et al. Severity Scores used in the assessment of Bronchiolitis: A systematic review. Abstract 2846. ERS 2021, 5–8 September.

 

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Posted on 9 November 2021