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.L6220914122018-05-16 <br />