Most Used Bronchiectasis Disease Severity Scores: Clinical Decision Tools For Your Daily Practice

Most Used Bronchiectasis Disease Severity Scores: Clinical Decision Tools For Your Daily Practice

April 30, 2024 — Denise Nedea

Currently, there are several well established and novel bronchiectasis disease severity scoring systems that help describe the extent of the structural lung abnormalities, to inform treatment management and help predict severity and prognosis, in cystic and non-cystic fibrosis related bronchiectasis.

We have selected 5 of the most used scores and built calculators for them, to facilitate their use through rapid, automatic scoring and result record keeping in clinical day to day assessments or research.

1

Bhalla Score

Stratifies bronchiectasis severity based on CT radiological findings in patients with cystic fibrosis. Open the Bhalla Score Calculator.


2

Modified Reiff Score

Evaluates the extent of bronchiectasis through site, type and extent on CT imagistic. Open the Modified Reiff Score Calculator.


3

Bronchiectasis Severity Index

BSI is a clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations. Open the BSI Calculator.


4

E-FACED Score

Evaluates disease severity and mortality risks associated with non-cystic fibrosis bronchiectasis based on exacerbations and clinical factors. Open the E-FACED Score Calculator.


5

Bronchiectasis Radiologically Indexed CT Score

BRICS assesses bronchiectasis severity based on bronchial dilatation and number of segments affected by emphysema. Open the BRICS Score Calculator.

Bronchiectasis severity scores have been developed by various authors for more than 30 years to evaluate the development of the disease and provide a standardisation of monitoring and treatment with the minimum possible variation between examiners.

Most scores focus on evaluating radiological and tomographic changes and enable the longitudinal evaluation of patients and standardized comparisons between them, in both clinical and research settings.

In 1991, Bhalla et al. published a detailed 9 item scoring system able to quantify structural lung abnormalities in patients with cystic fibrosis using thin section CT scans1. Further the score has been validated showing that CT assessment based on the Bhalla scoring system is more sensitive than pulmonary function tests in detecting initial morphologic changes.

Subsequent to that, in 1995, Reiff et al. developed a scoring system that assesses the radiological severity of bronchiectasis through the number of lobes involved (with the lingula considered to be a separate lobe) and the degree of dilatation2.

In 2014, Chalmers et al. derived and validated the Bronchiectasis Severity Index, another 9 item scoring system that can be used to stratify bronchiectasis severity, one and four year mortality and hospitalisation rates3. It uses clinical, radiological and microbiological findings to accurately identify patients with non-cystic fibrosis bronchiectasis at high risk of future mortality, hospital admissions, and exacerbations.

E-FACED score and its predecessor FACED facilitate the assessment of morbidity and mortality of people with non-cystic fibrosis bronchiectasis through various clinical, functional, radiological and microbiological variables. E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations and maintains the same predictive capacity for all-cause and respiratory mortality4.

The BRICS is the first radiological severity score correlating significantly with clinical parameters that can risk assess for severity. The BRICS was originally developed by thoracic radiologists and chest physicians in Edinburgh, Scotland, based on a multivariable analysis of the Bhalla score5. It is based on findings from 184 high resolution CT of the chest from a cohort of patients with idiopathic and postinfectious bronchiectasis.

Our Mission
MDApp is a digital healthcare solutions platform that advocates for the widespread adoption of clinical decision tools. We work closely with the research community to transform evidence-based medical algorithms, scoring systems etc. in easy to use calculators, to assist health professionals in their day to day practice and research.

References to original studies

1. Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman BS, McCauley DI, Naidich DP. Cystic fibrosis: scoring system with thin-section CT. Radiology. 1991; 179(3):783-8.

2. Reiff DB, Wells AU, Carr DH, Cole PJ, Hansell DM. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol. 1995; 165(2):261-7.

3. Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, Poppelwell L, Salih W, Pesci A, Dupont LJ, Fardon TC, De Soyza A, Hill AT (2014) The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. Mar 1;189(5):576-85

4. Martinez-Garcia MA, Athanazio RA, Girón R, Máiz-Carro L, de la Rosa D, Olveira C, de Gracia J, Vendrell M, Prados-Sánchez C, Gramblicka G, Corso Pereira M, Lundgren FL, Fernandes De Figueiredo M, Arancibia F, Rached SZ. Predicting high risk of exacerbations in bronchiectasis: the E-FACED score. Int J Chron Obstruct Pulmon Dis. 2017 Jan 18;12:275-284

5. Bedi P, Chalmers JD, Goeminne PC, Mai C, Saravanamuthu P, Velu PP, Cartlidge MK, Loebinger MR, Jacob J, Kamal F, Schembri N, Aliberti S, Hill U, Harrison M, Johnson C, Screaton N, Haworth C, Polverino E, Rosales E, Torres A, Benegas MN, Rossi AG, Patel D, Hill AT. The BRICS (Bronchiectasis Radiologically Indexed CT Score): A Multicenter Study Score for Use in Idiopathic and Postinfective Bronchiectasis. Chest. 2018; 153(5):1177-1186.

Denise Nedea

Denise created MDApp after recognising the need for medical professionals to have access to straightforward tools that support clinical decision making.

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