Disorders of Immunity and Respiration of the Paediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Eur J Pediatr. 2021 Jul;180(7):2065-2072. doi: 10.1007/s00431-021-03978-4. Epub 2021 Feb 13.
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.
毛细支气管炎的分层和预测是否需要入住儿科重症监护病房（PICU）极其困难。我们旨在评估新的肺部超声评分（LUSBRO）与临床评分相比预测需要入住 PICU 的能力。这是一项前瞻性观察性单中心研究，纳入了因急性毛细支气管炎而入住医院的<6 个月龄婴儿。在入院时计算了这两个评分。主要结局为入住 PICU。次要结局为需要机械通气、呼吸支持时间以及住院时间。共纳入 80 例患者，中位年龄为 53 天（IQR 29-115）。44 例（55%）患者需要入住 PICU。与临床评分相比，LUSBRO 评分在预测 PICU 入院方面具有更好的 AUC：0.932（95%CI 0.873-0.990）vs. 0.675（95%CI 0.556-0.794），且与住院时间呈正相关。预测 LUSBRO 评分需要入住 PICU 的最佳截断点为 6，其灵敏度为 90.91%，特异性为 88.89%。结论：LUSBRO 评分是预测需要入住 PICU 的有用工具。已知：- 分层患有毛细支气管炎的患者，哪些患者应早期转至三级医院并需要入住儿科重症监护病房（PICU）极其困难。- 已创建临床评分，但均不精确。新内容：- LUSBRO 评分是预测毛细支气管炎患者需要入住 PICU 的有用工具，因此可以预测需要转至三级医院以优化呼吸支持的患者。
