Iranian Journal of Neonatology

Iranian Journal of Neonatology

Bronchiolitis Severity Based on Modified Tal Score and Chest X-ray Findings; Is There any Association?

Document Type : Original Article

Authors
Niluofar Amini 1
Maryam Riahinezhad 2
Sepideh Faraji 1
Majid Keivanfar 1
1 1. Pediatrics Department, Emam Hossein children's hospital, Isfahan University of Medical Sciences, Isfahan, Iran 2. Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Radiology, Emam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
10.22038/ijn.2024.75677.2457
Abstract
Background: This study was performed to determine the relationship between chest X-ray findings and the severity of bronchiolitis using the modified Tal score scale (MTS).
Methods: This retrospective study was conducted among 999 children aged 2-24 months admitted to a referral teaching hospital in Isfahan, Iran. The severity of bronchiolitis was determined by MTS criteria, with scores ranging from 0 to 12. We considered scores 0-5 mild, 6-9 moderate, and 10-12 severe bronchiolitis. The patient's CXRs were also extracted from the hospital's picture archiving and communication system (PACS) and reported by an expert Pediatric radiologist. The radiologic findings were compared with the MTS criteria.Results: The mean (SD) of the MTS score in the patients was 4.58 ± 1.92. Overall, 757 patients (75.78%) had normal radiographies. The frequency of normal radiography was 75.3% in the group of mild bronchiolitis and 77.3% in the group of moderate bronchiolitis. Reports of 9 patients with severe disease showed that 6 of them had normal CXRs (66.7%), 2 had hyperinflation, and 1 had atelectasis. There was no statistically significant relationship between radiographic results and the severity of bronchiolitis, according to MTS criteria (P = 0.23). The agreement between radiographic results and the severity of bronchiolitis was very weak (0.004) without statistical significance (P = 0.632).
Conclusion: Considering that 99.3% of children with bronchiolitis do not have significant findings in chest X-rays, routine chest X-ray is not recommended in these patients.
 
Keywords
Bronchiolitis
Early warning score
Mass chest X-ray
  1. Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med. 2018;18(1):191.
  2. Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62-72.
  3. Teshome G, Gattu R, Brown R. Acute bronchiolitis. Pediatr Clin North Am. 2013;60(5):1019-1034.
  4. Gökçe Ş, Kurugöl Z, Koturoğlu G, Çiçek C, Aslan A. Etiology, seasonality, and clinical features of viral respiratory tract infections in children hospitalized with acute bronchiolitis: A single-center study. Glob Pediatr Health. 2017;4:2333794X17714378.
  5. Ricci V, Delgado Nunes V, Murphy MS, Cunningham S. Guideline development group and technical team. bronchiolitis in children: summary of NICE guidance. BMJ. 2015;350:h2305.
  6. Breakell R, Thorndyke B, Clennett J, Harkensee C. Reducing unnecessary chest X-rays, antibiotics and bronchodilators through implementation of the NICE bronchiolitis guideline. Eur J Pediatr. 2018;177(1):47-51.
  7. Frazier SB, Walls C, Jain S, Plemmons G, Johnson DP. Reducing chest radiographs in bronchiolitis through high-reliability interventions. Pediatrics. 2021; 148(3):e2020014597.
  8. Friedman JN, Rieder MJ, Walton JM, Canadian Paediatric Society. Drug Therapy and Hazardous Substances Committee. Bronchiolitis: Recommen-dations for diagnosis, monitoring and management of children one to. 2014;24:485-498. 
  9. Shahraki Mojahed B, Saravani K, Parooie F. Thoracic staging in patients with non-small cell lung cancer: A systematic review and meta-analysis on diagnostic accuracy of [18F]FDG PET/MRI and [18F]FDG PET/CT. Nucl Med Rev Cent East Eur. 2023;26:11-19..
  10. Rodriguez-Martinez CE, Sossa-Briceño MP, Nino G. Systematic review of instruments aimed at evaluating the severity of bronchiolitis. Paediatr Respir Rev. 2018;25:43-57.
  11. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-1
  12. Golan-Tripto I, Goldbart A, Akel K, Dizitzer Y, Novack V, Tal A. Modified tal score: Validated score for prediction of bronchiolitis severity. Pediatr Pulmonol. 2018;53(6):796-801.
  13. Kamble MB, Singh RK. Applicability of respiratory severity score and modified TAL criteria in pediatric age group for grading and management of acute respiratory illness. Int J Paediatrics Geriatrics. 2020,7(3):532-539.
  14. Golan-Tripto I, Loewenthal N, Tal A, Dizitzer Y, Baumfeld Y, Goldbart A. Vitamin D deficiency in children with acute bronchiolitis: a prospective cross-sectional case- control study. BMC Pediatr. 2021;21(1):211.
  15. Shinta Devi NLP, Wanda D, Nurhaeni N. The validity of the modified tal score and wang respiratory score instruments in assessing the severity of respiratory system disorders in children. Compr Child Adolesc Nurs. 2019;42(sup1):9-20.
  16. Murch H, Oakley J, Pierrepoint M, Powell C. Using multifaceted education to improve management in acute viral bronchiolitis. Arch Dis Child. 2015;100(7):654-658.
  17. Arnoux V, Carsin A, Bosdure E, Retornaz K, Chabrol B, Gorincour G, et al. Chest X-ray and acute bronchiolitis: Are these indications decreasing? Arch Pediatr. 2017;24(1):10-16. French.
  18. Nazif JM, Taragin BH, Azzarone G, Rinke ML, Liewehr S, Choi J. Esteban-cruciani n. clinical factors associated with chest imaging findings in hospitalized infants with bronchiolitis. Clin Pediatr (Phila). 2017;56(11):1054-1059.
  19. Cavari Y, Shlomo TL, Neeman E, Taragin B, Leder M. Intrapulmonary percussive ventilation for children with bronchiolitis on non-invasive ventilation support. Open J Pediatr Child Health. 2022;7(1):025-0
  20. Rius Peris JM, Maraña Pérez AI, Valiente Armero A, Mateo Sotos J, Guardia Nieto L, Torres AM, et al. The chest x-ray in acute bronchiolitis: Technical quality, findings, and an assessment of its reliability. An Pediatr (Engl Ed). 2021;94(3):129-135. Spanish.
  21. Zipursky A, Kuppermann N, Finkelstein Y, Zemek R, Plint AC, Babl FE, et al., International practice patterns of antibiotic therapy and laboratory testing in bronchiolitis. 2020;146(2): e20193684.
  22. Friedman JN, Davis T, Somaskanthan A, Ma A. Avoid doing chest x rays in infants with typical bronchiolitis. BMJ. 2021;375:e064132. 
  23. Kirolos A, Manti S, Blacow R, Tse G, Wilson T, Lister M, et al. A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis. J Infect Dis. 2020;222(Suppl 7):S672-S679.
  24. Fretzayas A, Moustaki M. Etiology and clinical features of viral bronchiolitis in infancy. World J Pediatr. 2017;13(4):293-299.
  25. Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150(4):429-433.
  26. Yong JH, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, et al. A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis. Pediatr Pulmonol. 2009;44(2):122-127.
Iranian Journal of Neonatology
Volume 15, Issue 3
Summer 2024
Pages 24-30