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

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