Written by Chris Thom
Spoon Feed
When using lung ultrasound (LUS) to predict decompensation of infants with bronchiolitis, a more comprehensive approach with additional views was superior.
Lung ultrasound surpasses clinical severity scores in predicting decompensation
This was a single center prospective study of infants < 12 months who were hospitalized with bronchiolitis. One of three trained pediatricians performed LUS within 12 hours of hospitalization and prior to any advanced respiratory support. The treatment team was blinded to the LUS findings. Investigators performed two different protocols, the Concise Score (6 total lung zones, none posterior) and the Extended Score (12 total lung zones, including posterior). Patients were then followed during the hospitalization to assess for need of respiratory support, defined as high-flow nasal cannula, non-invasive positive pressure ventilation, and intubation.
There were 160 infants enrolled, with a median age of 65.5 days. 87 infants (54.4%) required advanced respiratory support. The Concise Score demonstrated 79.3% sensitivity and 67.1% specificity, while the Extended Score demonstrated 89.7% sensitivity and 78.1% specificity. The clinical Wang score was used as a comparator, which had sensitivity of 44.3% and specificity of 80.6%.
How does this change my practice?
How much LUS is enough is a common question in point of care ultrasound. The exam is easy to perform, but can be time-consuming depending on the number of zones and fields one needs to cover. In the current study, the authors found both approaches were superior to a clinical severity score. However, the approach involving the posterior lungs added diagnostic accuracy. LUS appears to have a place in the algorithm for who is at risk for decompensation. The next step would be to see if LUS offers value in helping physicians determine who needs admission and is at risk of decompensation in the outpatient environment.
Ultrasound acquisition pro-tips:
The pediatric lung is a friendly place for POCUS. Using the linear probe and a low depth setting, one will invariably obtain clear lung images. The question remains how many windows you need to obtain, but the current study suggests that capturing at least a few anterior, lateral, and posterior windows is worth your time. The severity scoring system for bronchiolitis uses a 4 stage scale, where increasing B-lines and then consolidation are given higher scores. B lines appear as hyperechoic vertical lines that populate through the entire depth of the lung field, while consolidation in bronchiolitis will often appear as a hypoechoic area just below the pleura with occasional air bronchograms visible.
Source
Extended vs. concise lung ultrasound scores to predict the need for respiratory support in bronchiolitis: a prospective observational study. Eur J Pediatr. 2025 May 23;184(6):357. doi: 10.1007/s00431-025-06189-3. PMID: 40410579
