Lung POCUS valuable for predicting bronchiolitis severity in pediatric emergency settings

Acute bronchiolitis (AB) is infants' most common lower respiratory tract infection. The condition involves a series of inflammatory responses that leads to edema and bronchial congestion. Due to the risk of respiratory failure, patients in these cases require advanced airway support.

A study published in The American Journal of Emergency Medicine has concluded that Higher lung ultrasound (LUS)scores for AB are associated with increased respiratory support, longer length of stay (LOS) and more acute disposition. Using bedside LUS in the ED may assist the clinician in treating patients diagnosed with AB.

Objective scoring tools and plain film radiography have limited application. The diagnosis is clinical. Researchers studied the role of point-of-care lung ultrasound (LUS) in the present setting. They demonstrated associations with respiratory support at 12 and 24 hours, maximum respiratory support during hospitalization, disposition, and hospital length of stay.

Eighty-two subjects were enrolled, and the Physician performed LUS at the bedside. The lung was divided into 12 segments, and then the scanning, scoring, and summation were done in real-time based on the following categories: 0 – A-lines with less than 3 B lines per lung segment, 1 - having three or more B lines per lung segment but not consolidated, 2 - having consolidated B lines but no subpleural consolidation, and 3 - having subpleural consolidation with any findings scoring 1 or 2. A chart review was performed for all patients after their discharge from the hospital The categories for RS were RS (room air), low RS (wall O2 or heated high-flow nasal cannula <1 L/kg), and high RS (heated high-flow nasal cannula ≥1 L/kg or positive pressure).

Key findings from this study are:

• Regarding disposition, the mean LUS scores were: discharged 1.18; admitted to the floor 4.34; and admitted to the ICU 10.84.

• The mean LUS scores for RS at 12 h were: no RS 1.56, low RS 4.34, and high RS 11.94.

• At 24 h, it was no RS 2.11, low RS 4.91 and high RS 12.64.

• Maximum RS included no RS 1.22, low RS 4.11 and high RS 10.45.

• Mean differences for all dispositions and RS time points were significant.

• The mean hospital LOS was 84.5 h.

• The Pearson correlation coefficient (r) comparing LOS and LUS was 0.489

Study limitations include variability, inherent biases, missed enrollment, or the number excluded was not captured and related to sample size.

Concluding further, they said, "Among Infants diagnosed with AB in the ED, our LUS scoring system is significantly associated with the need for RS, ED disposition, and hospital LOS and may be valuable as an objective tool in assessing severity of AB disease.

Reference:

Smith, Jaron A., et al. "Association of Outcomes in Point-of-care Lung Ultrasound for Bronchiolitis in the Pediatric Emergency Department." The American Journal of Emergency Medicine, Elsevier BV, Oct. 2023.