Extended vs. concise lung ultrasound scores to predict the need for respiratory support in bronchiolitis: a prospective observational study

Lung ultrasound (LUS) has emerged as a valuable tool for assessing bronchiolitis severity, yet the optimal scoring system remains uncertain. This study aimed to compare the predictive performance of two LUS scoring methods-concise vs. extended-for determining the need for respiratory support in infants hospitalized with bronchiolitis. We conducted a prospective observational study including infants < 12 months hospitalized for bronchiolitis. All patients underwent LUS within 12 h of admission, performed by trained pediatricians blinded to clinical outcomes. The concise score assessed three lung regions per hemithorax, whereas the extended score included six regions per hemithorax. The primary outcome was the need for respiratory support (high-flow nasal cannula, noninvasive ventilation, or invasive mechanical ventilation). Interobserver agreement was assessed via the intraclass correlation coefficient (ICC). A total of 160 infants were included, with 87 (54.4%) requiring respiratory support. The extended LUS score demonstrated superior predictive performance (AUC = 0.879, 95% CI 0.824-0.934) compared to the concise score (AUC = 0.761, 95% CI 0.686-0.837, p < 0.001). The optimal cutoffs were 14 for the extended score (89.7% sensitivity, 78.1% specificity) and 7 for the concise score (79.3% sensitivity, 67.1% specificity). Interobserver reliability was good for both scores (ICC = 0.86 and 0.79). Conclusion: The extended LUS score exhibited higher predictive accuracy but at the expense of increased complexity. While both scores demonstrated clinical utility, further studies should explore the balance between feasibility and precision in bronchiolitis management. What is Known: center dot Lung ultrasound (LUS) is increasingly used to assess the severity of bronchiolitis in infants. center dot Several LUS scoring systems exist, but there is no consensus on which score best predicts the need for respiratory support. What is New: center dot This study prospectively compares a concise and an extended LUS score to predict the need for advanced respiratory support in hospitalized infants. center dot The extended score had significantly higher diagnostic accuracy and clinically oriented cut-offs to guide triage decisions.