Brasfield Score for Cystic Fibrosis Severity
Assesses cystic fibrosis severity based on chest radiographic findings.
You can find more information about the score and associated research in the text below the score.
The Brasfield scoring system is the most commonly accepted method for assessing pulmonary findings in cystic fibrosis using chest radiography.
To obtain the Brasfield score, you start at 25 then subtract the individual points assigned to the options selected to the 5 categories of the score. Therefore the final scores range from 25 (normal exam) to 3, the most severe disease.
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Brasfield explained
The Brasfield scoring system is a disease severity model applicable to patients with cystic fibrosis based on scoring conventional chest radiograph findings. The score has shown good correlation with pulmonary function.
Points are assigned to five items as follows:
| Brasfield Items | Points | |
| Air trapping Generalised pulmonary overdistension (sternal bowing, depression of diaphragms, or thoracic kyphosis) |
Absent | 0 |
| Increasing severity (mild) | 1 | |
| Increasing severity (moderate) | 2 | |
| Increasing severity (severe) | 3 | |
| Most severe | 4 | |
| Linear markings Linear opacification due to prominence of bronchi; may be seen as parallel line densities, branching, or “end-on” circular densities (bronchial wall thickening) |
Absent | 0 |
| Increasing severity (mild) | 1 | |
| Increasing severity (moderate) | 2 | |
| Increasing severity (severe) | 3 | |
| Most severe | 4 | |
| Nodular cystic lesions Multiple discrete rounded densities ≥0.5 cm in diameter, with either radiopaque or radiolucent centres (bronchiectasis); does not refer to irregular linear markings; confluent nodules not classified as large lesions |
Absent | 0 |
| One quadrant involved | 1 | |
| Two quadrants involved | 2 | |
| Three quadrants involved | 3 | |
| Four quadrants involved | 4 | |
| Large lesions Segmental or lobar atelectasis or consolidation, includes acute pneumonia. |
Absent | 0 |
| Segmental or lobar atelectasis or pneumonia | 3 | |
| Large lesions | 5 | |
| General severity Impression of overall severity of changes on chest x-ray |
Normal | 0 |
| Increasing severity of abnormalities (mild) | 1 | |
| Increasing severity of abnormalities (moderate) | 2 | |
| Increasing severity of abnormalities (severe) | 3 | |
| Most severe abnormalities | 4 | |
| Cardiac enlargement or pneumothorax | 5 | |
The Brasfield score is obtained by subtracting the sum of the 5 individual points assessed from 25 and ranges from 3 to 25. A score of 25 is a normal exam and a score of 3 (the minimum possible) is the most severe disease.
About the original study and further research
The score has been developed and validated following a collaborative study involving 16 cystic fibrosis centers, 22 observers and more than 1,700 independent observations.
Analysis of the data confirms a moderately high degree of reproducibility by and among observers and indicates that this scoring system could be used in the assessment of patients with cystic fibrosis.
When compared, on a cohort of 30 patients with CXRs during a 5-year period, Brasfield and Wisconsin systems performed very similarly providing equally reproducible, robust and reliable measures.
Most recent research has explored the possibility of scoring the Brasfield by a deep convolutional neural network (DCNN) model and compared it with paediatric radiologist observations in a retrospective study of 2058 frontal/lateral chest radiographs.
A DCNN model is promising for predicting CF Brasfield scores with accuracy similar to that of a paediatric radiologist.
References
Original reference
Brasfield D, Hicks G, Soong S. et al. Evaluation of scoring system of the chest radiograph in cystic fibrosis: a collaborative study. AJR Am J Roentgenol. 1980; 134 (6): 1195-8.
Other references
Cleveland RH, Neish AS, Zurakowski D. et al. Cystic fibrosis: a system for assessing and predicting progression. AJR Am J Roentgenol. 1998; 170 (4): 1067-72.
Cleveland RH, Stamoulis C, Sawicki G, Kelliher E, Zucker EJ, Wood C, Zurakowski D, Lee E. Brasfield and Wisconsin scoring systems have equal value as outcome assessment tools of cystic fibrosis lung disease. Pediatr Radiol. 2014; 44(5):529-34.
Zucker EJ, Barnes ZA, Lungren MP, Shpanskaya Y, Seekins JM, Halabi SS, Larson DB. Deep learning to automate Brasfield chest radiographic scoring for cystic fibrosis. J Cyst Fibros. 2020; 19(1):131-138.
Specialty: Pulmonology
System: Respiratory
Objective: Disease severity
Type: Score
No. Of Items: 5
Year Of Study: 1980
Article By: Denise Nedea
Published On: September 25, 2024
Last Checked: September 25, 2024
Next Review: September 25, 2029