Development and validation of a bronchoscopically defined bronchitis scoring tool in children

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Medical Imaging

Background:

• Flexible bronchoscopy (FB) is crucial for diagnosing pediatric respiratory conditions.
• A validated tool for scoring bronchitis during FB is needed for consistent clinical practice and research.
• Existing methods lack standardized visual assessment criteria for pediatric bronchitis.

Purpose of the Study:

• To develop and validate a bronchoscopically defined bronchitis scoring system in children, termed BScore.
• To correlate visual findings during FB with bronchoalveolar lavage (BAL) neutrophil percentage.
• To establish a reliable tool for quantifying airway inflammation in pediatric bronchitis.

Main Methods:

• Prospective enrollment of children undergoing FB.
• Digital recording and blinded assessment of six key features: secretion amount/color, mucosal edema, ridging, erythema, and pallor.
• Correlation of each feature with BAL neutrophil percentage using Spearman's rho.
• Derivation of BScore using feature combinations and evaluation with receiver operating characteristic (ROC) curves.

Main Results:

• 142 children were analyzed; chronic/recurrent cough was the primary indication for FB.
• Secretion amount/color, mucosal edema, and erythema significantly correlated with BAL neutrophil percentage (P < .0001).
• A BScore model excluding pallor achieved the highest area under the ROC curve (aROC = 0.84), effectively identifying airway neutrophilia (>10% BAL neutrophils).

Conclusions:

• The study successfully developed the first validated bronchitis scoring tool for children based on bronchoscopic visual inspection.
• The BScore demonstrates potential for objective assessment of airway inflammation in pediatric bronchitis.
• Further validation in diverse pediatric cohorts is recommended to confirm generalizability.