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Allergologia et Immunopathologia
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Inicio Allergologia et Immunopathologia A comparison of two clinical scores for bronchiolitis. A multicentre and prospec...
Journal Information
Vol. 46. Num. 1.January - February 2018
Pages 1-104
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Vol. 46. Num. 1.January - February 2018
Pages 1-104
Original Article
DOI: 10.1016/j.aller.2017.01.012
A comparison of two clinical scores for bronchiolitis. A multicentre and prospective study conducted in hospitalised infants
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C. Rivas-Juesasa,
Corresponding author
rivas_cri@gva.es

Corresponding author.
, J.M. Rius Perisb, A.L. Garcíaa, A.A. Madramanyc, M.G. Perisd, L.V. Álvareze, J. Primoa
a Hospital de Sagunto, Avda Ramón y Cajal s.n, Sagunto, 46520 Valencia, Spain
b Hospital Virgen de la Luz, Hermandad de Donantes de Sangre n° 1, 16002 Cuenca, Spain
c Hospital Universitario de La Ribera, Carretera de Corbera s/n, Alzira 46600, Spain
d Hospital LLuis Alcanyís, Crta, Xátiva a Silla Km 2, Xátiva, 46800 Valencia, Spain
e Hospital de Vinaroz, Castellón, Spain
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Figures (1)
Tables (7)
Table 1. Comparison of the epidemiological and clinical characteristics of the patients with acute bronchiolitis according to severity.
Table 2. Agreement among scales. Weighted kappa coefficient.
Table 3. Analysis of sensitivity, specificity, PPV, NPV and likelihood ratios of the cases of bronchiolitis in reference to the WDF scale.
Table 4. Analysis of sensitivity, specificity, PPV, NPV and likelihood ratios of the cases of bronchiolitis in reference to the ESBA scale.
Table 5. Analysis of sensitivity, specificity, PPV, NPV and likelihood ratios of the cases of bronchiolitis in reference to the WDF and ESBA scale, with the cut-off points derived from the study sample. Estimation of the Youden index (J) and optimum cut-off point (c*) of the scale for the sample (WDF >5 points and ESBA >6 points).
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Abstract
Background

There are a number of clinical scores for bronchiolitis but none of them are firmly recommended in the guidelines.

Method

We designed a study to compare two scales of bronchiolitis (ESBA and Wood Downes Ferres) and determine which of them better predicts the severity. A multicentre prospective study with patients <12 months with acute bronchiolitis was conducted. Each patient was assessed with the two scales when admission was decided. We created a new variable “severe condition” to determine whether one scale afforded better discrimination of severity. A diagnostic test analysis of sensitivity and specificity was made, with a comparison of the AUC. Based on the optimum cut-off points of the ROC curves for classifying bronchiolitis as severe we calculated new Se, Sp, LR+ and LR− for each scale in our sample.

Results

201 patients were included, 66.7% males and median age 2.3 months (IQR=1.3–4.4). Thirteen patients suffered bronchiolitis considered to be severe, according to the variable severe condition. ESBA showed a Se=3.6%, Sp=98.1%, and WDF showed Se=46.2% and Sp=91.5%.

The difference between the two AUC for each scale was 0.02 (95%CI: 0.01–0.15), p=0.72. With new cut-off points we could increase Se and Sp for ESBA: Se=84.6%, Sp=78.7%, and WDF showed Se=92.3% and Sp=54.8%; with higher LR.

Conclusions

None of the scales studied was considered optimum for assessing our patients. With new cut-off points, the scales increased the ability to classify severe infants. New validation studies are needed to prove these new cut-off points.

Keywords:
Bronchiolitis
Infants
Clinical scores
Diagnostic test
ROC curves
Abbreviations:
ESBA
WDF
AUC
ROC
Se
Sp
LR+
LR−
ICU

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