336 - Comparison of clinical severity scales for acute bronchiolitis in the emergency department

Poster Number: 336
Publication Number: 336.204

Elena Granda, University of Valladolid, Valladolid, Castilla y Leon, Spain; Mario Urbano, Rio Hortega University Hospital, Valladolid, Castilla y Leon, Spain; Marina Corchete Cantalejo, RIO HORTEGA UNIVERSITY HOSPITAL, Valladolid, Castilla y Leon, Spain; Alfredo Cano, Hospital Universitario Rio Hortega, Valladolid, Castilla y Leon, Spain; Roberto Velasco, Hosp. Univ. Río Hortega, Laguna de Duero, Castilla y Leon, Spain

Background: A recent systematic review of 32 validated clinical scores for bronchiolitis (Rodriguez-Martinez et al, Pediatr Respir Rev 2018) concluded that 6 of them [Wood-Downes, M-WCAS, Respiratory Severity Score (Rodriguez et al.), Respiratory Clinical Score (Liu et al.), Respiratory Score (Gajdos et al.) and Bronchiolitis risk of admission score (Marlais et al.)] were the best ones regarding reliability, sensitivity, validity and usability. However, to the best of our knowledge, no study has compared all of them in a real clinical scenario. Also, after this review, three more scales were published: BROSJOD, Tal modified and one score developed by PERN.

Objective: Our main aim was to compare the ability of different clinical scales for bronchiolitis to predict any relevant outcome.

Design/Methods: Prospective observational study that included patients up to 12 months old attended to due to bronchiolitis in the Pediatric Emergency Department (PED) of a university hospital from Oct-2019 to Sep-2021. For each patient, the attending clinician filled in a form with the items of the scales, decomposed, in order to avoid bias. A phone call was made to each patient in order to check whether the patient ended up being admitted in the next 48 hours. In those that were impossible to contact by phone, the clinical history was reviewed. For the purpose of the study, it was considered as a relevant outcome the need for supplementary oxygen, non-invasive ventilation (NIV), intravenous fluids, admission to the intensive care unit within the next 48 hours or death.

Results: We included 208 patients (52.9% male) with a median age of 5.3 months (IQR 2.5 - 7.4). Among them, 47 (22.6%) had at least one relevant outcome. Area under the curve for prediction of a relevant outcome ranged from 0.681 (Gajdos) to 0.804 (PERN), although no scale performed significantly better than others (Figure 1). The best cut-off point of each scale was estimated according to the Youden index. In Figure 2, sensitivity (Sn) and specificity for a relevant outcome of each cut off point is shown. A score ≤2 in PERN scale showed a Sn of 89.4% (CI95% 77.4-95.4) for a relevant outcome, with only 5 misdiagnosed patients (none of them needed NIV).Conclusion(s): There were no differences in the performance of the nine scales to predict admission in patients with bronchiolitis. However, PERN scale might be more useful to select patients at low risk of a severe outcome.
Figure 1. Area under the curve of each clinical scale for prediction of a relevant outcome.Diapositiva1.jpeg
Figure 2. Diagnostic values of each scale’s best cut-off point to predict any relevant outcome.