Bronchiolitis Severity Scores for Predicting Mechanical Ventilation Needs in Children With Respiratory Syncytial Virus.
Source: PubMed, NCBI / U.S. National Library of Medicine
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. 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). 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 Bonferro
Abstract
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. 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). 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%). 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.