Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study)

Abstract

It is extremely difficult to stratify bronchiolitis and predict the need for admission to the pediatric intensive care unit (PICU). We aimed to evaluate the capacity of a new lung ultrasound score (LUSBRO) to predict the need for admission to the PICU compared to a clinical score. This was a prospective observational single-center study that includes infants < 6 month of age admitted to a hospital due to acute bronchiolitis. Both scores were calculated at admission. The main outcome was PICU admission. Second endpoints were the need for mechanical ventilation, respiratory support duration, and the length of stay in the hospital. Eighty patients were included, with a median age of 53 days (IQR 29–115). Forty-four patients (55%) required PICU admission. LUSBRO score showed a better AUC compared to the clinical score to predict PICU admission: 0.932 (95% CI 0.873–0.990) vs. 0.675 (95% CI 0.556–0.794) and a positive correlation with the hospital length of stay. The best cut-off point for predicting the need for PICU admission for LUSBRO score was 6, showing a sensitivity of 90.91% and a specificity of 88.89%.

Conclusions: The LUSBRO score is a useful tool to predict the need for admission to the PICU.

What is Known
It is extremely difficult to stratify which patients affected by bronchiolitis should be precociously transferred to a third level hospital and will require pediatric intensive care unit (PICU) admission.
Clinical scores have been created but neither of them is accurate.
What is New
The LUSBRO score is a useful tool to predict the need for admission to the PICU of patients with bronchiolitis and, consequently, to predict the patients who should be transferred to a tertiary hospital to optimize respiratory support.

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Availability of data and material

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Code availability

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Abbreviations

LUS:

Lung ultrasound

PICU:

Pediatric intensive care unit

CXR:

Chest X-ray

NIV:

Non-invasive ventilation

HFNC:

High-flow nasal cannula

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Acknowledgements

To the children and families which accepted to join the study.

Author information

Affiliations

Authors

Contributions

JRF, SBP, PG, MC, NLL CS, and MR conceived and designed the study. JRF and SBP analyzed the data. JRF, SBP, CS, wrote the first draft of the manuscript. JRF, SBP, PG, MC, NLL CS, and MR contributed to the writing of the manuscript. All authors agree with the manuscript results and conclusions, jointly developed the structure and arguments for the paper, made critical revisions, and reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Rodriguez-Fanjul Javier.

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Ethical approval and consent to participate

Parental informed consent was obtained from all patients.

Consent for publication

This study was approved by the local Ethical Assistance Committee and the institutional review board. This study was approved by the local Ethical Assistance Committee and the institutional review board.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

Supplementary information

Supplementary Figure 1
figure4

Violin plot representing the different values of the LUSBRO score (plot 1) and BROSJOD score (plot 2) regarding the maximum support required during the hospital admission. HFNC: high-flow nasal cannula; MV: mechanical ventilation; NC: nasal cannula; NIV: non-invasive ventilation. (PNG 8951 kb).

High Resolution Image (TIFF 175 kb).

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Cite this article

Sara, BP., Clara, S., Paula, G. et al. Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study). Eur J Pediatr (2021). https://doi.org/10.1007/s00431-021-03978-4

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Keywords

  • Ultrasound
  • Bronchiolitis
  • Pediatric intensive care