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

Abstract

Introduction Lung Ultrasound (LUS) has demonstrated good correlation with clinical severity scores in bronchiolitis but should be combined with clinical data to achieve best results. Aim of the study is to create a quick and reliable clinical-ultrasound score to predict the risk of Pediatric Intensive Care (Picu) admission as soon as the patient enters the Emergency Department (ED). Methods Retrospective study conducted at two pediatric EDs. 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 ventilation”, a multivariate analysis was conducted and the significant factors resulting were used to create a 3- items score to predict Picu admission. Area under the Receiver-Operating Curve (AUC) for specificity and sensibility of the score was obtained. Results 74 patients were enrolled; 34% were admitted to PICU. 31% were treated with CPAP. For the outcome “PICU admission”, multivariate analysis demonstrated 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 ventilation”, same clinical factors plus involvement of Right Posterior Upper Zone were significant. A 3-items 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 need for PICU admission in bronchiolitis.