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Bronchiolitis Severity Scores for Predicting Mechanical Ventilation Needs in Children With Respiratory Syncytial
Ayu Ogura Kawakami1, Koji Kanno2, Yusuke Ito2
1Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.
Insights
Bronchiolitis severity scores may help predict mechanical ventilation in children admitted to the pediatric intensive care unit (PICU). The Bronchiolitis Score of Sant Joan de Déu (BROSJOD) showed promising predictive performance.
Area of Science:
- Pediatric intensive care
- Respiratory medicine
- Clinical scoring systems
Background:
- Respiratory syncytial virus (RSV) bronchiolitis frequently leads to respiratory failure and PICU admission in infants.
- Predicting the need for mechanical ventilation in these young patients is a significant clinical challenge.
Purpose of the Study:
- To evaluate the effectiveness of three established bronchiolitis severity scores in predicting the requirement for mechanical ventilation in children admitted to the PICU.
- To compare the predictive performance of the Modified Wood's Clinical Asthma Score (M-WCAS), Bronchiolitis Score of Sant Joan de Déu (BROSJOD), and Pediatric Emergency Research Network (PERN) score.
Main Methods:
- A single-center retrospective study included 31 children under 24 months with RSV bronchiolitis admitted to the PICU.
- Three severity scores (M-WCAS, BROSJOD, PERN) were applied retrospectively.
- Area under the receiver operating characteristic curve (AUC) was used to assess predictive performance for mechanical ventilation.
Main Results:
- Five of the 31 children required mechanical ventilation.
- The BROSJOD score demonstrated the highest predictive performance with an AUC of 0.912 (cutoff ≥12), sensitivity 1.000, and specificity 0.731.
- The PERN score (AUC 0.827) and M-WCAS (AUC 0.685) also showed predictive value, though BROSJOD was notably sensitive.
Conclusions:
- Bronchiolitis severity scores, particularly BROSJOD, may aid in identifying children needing mechanical ventilation without causing treatment delays.
- No single score was definitively superior, and further research is warranted.
- Larger prospective studies are necessary to confirm these findings and establish definitive clinical utility.
Background:
Respiratory syncytial virus (RSV) bronchiolitis is a common cause of respiratory failure requiring pediatric intensive care unit (PICU) admission in young children. Predicting the need for mechanical ventilation remains challenging. We evaluated the usefulness of bronchiolitis severity scores for predicting mechanical ventilation after PICU admission.
Methods:
We conducted a single-center retrospective study of children with RSV bronchiolitis admitted to our PICU between April 2021 and July 2023. Inclusion criteria were age < 24 months, no underlying respiratory disease, and no prior positive-pressure ventilation. Three bronchiolitis severity scores were retrospectively applied: Modified Wood's Clinical Asthma Score (M-WCAS), Bronchiolitis Score of Sant Joan de Déu (BROSJOD), and Pediatric Emergency Research Network (PERN) score. Predictive performance for subsequent mechanical ventilation was assessed using the area under the receiver operating characteristic curve (AUC).
Results:
Thirty-one children met the inclusion criteria, and 5 required mechanical ventilation. The median time to mechanical ventilation was 362 min. For predicting mechanical ventilation, BROSJOD (cutoff ≥ 12) showed sensitivity 1.000, specificity 0.731, and AUC 0.912; M-WCAS (cutoff ≥ 4.5) showed sensitivity 0.800, specificity 0.615, and AUC 0.685; and PERN (cutoff ≥ 10) showed sensitivity 1.000, specificity 0.577, and AUC 0.827. DeLong test with Bonferroni correction showed no significant differences among the three scores, although the study was underpowered (estimated power ≤ 27%).
Conclusion:
These bronchiolitis severity scores may help identify the need for mechanical ventilation without delaying intervention. No score was clearly superior, and larger prospective studies are needed.
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