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S75 The development and validation of a clinical severity score for infants with bronchiolitis
  1. C van Miert1,
  2. J Abbott2,
  3. F Verhoeff1,
  4. S Lane3,
  5. B Carter2,
  6. PS McNamara3
  1. 1Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  2. 2University of Central Lancashire, Preston, UK
  3. 3University of Liverpool, Liverpool, UK


Introduction and Objectives Bronchiolitis is a viral lower respiratory tract infection of infancy.11–3% of all infants are admitted to hospital with 3% of hospitalised infants requiring critical care.2

Objective To develop and validate a scoring instrument for use by health care professionals (HCPs) in infants with bronchiolitis which has clinical utility.

Methods Psychometric methods were used to develop the scoring instrument and to test the instrument for validity and reliability in a variety of clinical locations.

Results Item generation, reduction & instrument development: 101 items were identified from the literature and focus group workshops (families & HCPs). Consensus for importance was achieved for 45 items (Table 1) following a Delphi survey of 195 HCPs. A scoring instrument with 12 domains was developed.

Abstract S75 Table 1.

Signs, symptoms & risk factors.

Content validity: The scoring instrument was applied to infants (n = 115) by HCPs who were asked to rate each item/domain for clinical relevance. All items/domains were assessed as relevant. However there were substantial missing data for two domains (chest auscultation/blood gas analysis) as certain HCP groups could not undertake these procedures. These two domains were consequently removed.

Cognitive interviewing: HCPs (n = 15) were interviewed in order to assess comprehension, interpretation and how they arrived at their responses for each item/domain in the scoring instrument. Understanding of medical vocabulary was assessed. ‘Sub-sternal recession’ was removed and ‘anuric’ changed to ‘not passed urine’.

Construct validity & paediatrician inter-rater reliability: HCPs applied the scoring instrument to infants (n = 128) whilst two senior doctors assessed whether the infant had ‘mild’, ‘moderate’ or ‘severe’ bronchiolitis. Cut points within the score have now been established for ‘mild’, ‘moderate’ and ‘severe’ bronchiolitis.

Conclusions We have developed and partially validated a clinical severity score for infants with bronchiolitis. Criterion and reliability testing of the score is planned for the 2013/14 bronchiolitis season. Responsiveness to change will be assessed in a future clinical trial.


  1. Bialy L et al. The Treatment of Bronchiolitis in Children: An Overview of Reviews. Evid.-Based Child Health 2011; 6: 258–275

  2. Damore D et al. Prospective multicentre bronchiolitis study: predicting ICU admissions. Acad Emerg Med 2008; 15(10): 887–894.

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