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

Abstract

IntroductionLung 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).MethodsA 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.ResultsSeventy-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.ConclusionsWe were able to create a simple and quick score to predict the need for PICU admission in bronchiolitis.