Development and validation of a bronchoscopically defined bronchitis tool in children

Abstract

Introduction/Aim No validated tool exists for scoring bronchitis (i.e. airway inflammation) during flexible bronchoscopy (FB) despite potential clinical and research usefulness. Thus, we aimed to develop a bronchoscopically defined bronchitis scoring system in children (Bscore).

Methods We used methods from our retrospective study; FB recordings were assessed for 6 components: amount of secretions (scores 1‐6), colour of secretions (BronkoTest, 0‐8), mucosal oedema (0‐3), ridging (0‐3), erythema (0‐3) and pallor (0‐3) based on pre‐determined criteria. BScore was derived using several models developed from various combinations of the each of the 6 components that best related to airway neutrophilia (in BAL). We also determined the correlations (Spearman) between each component with BAL neutrophil%. Clinical history was obtained from parent(s) who consented for study inclusion before the FB undertaken. A clinician blinded to the child's history scored the FB. The various models of BScore were plotted against neutrophil% using a receiver operating characteristic (ROC) curve. Here we report our preliminary findings; we plan to enrol >100 children.

Results Chronic/recurrent cough was the commonest indication for FB in the 30 children enrolled (median age=3‐years). Secretion amount and colour had the strongest correlation with BAL neutrophil%, (r=0.409, p=0.025 and r=0.401, p=0.028 respectively). With inflammation defined as BAL neutrophilia >15%, the highest aROC (0.68, 95%CI 0.45‐0.91) was obtained by tripling the secretion scores (amount and colour) and excluding pallor. aROC for the model derived from our retrospective study was 0.63 (95%CI 0.50‐0.76). The highest aROC (0.86, 95%CI 0.71‐1.00) was with neutrophils of >10% using the BScore obtained by each of the 6 components.

Conclusion A validated bronchoscopic defined bronchitis scoring system can be obtained from visualization of airway secretions (amount and colour) and mucosa appearances (erythema, ridging and oedema). Further data is however required.