Erik E Folch1, Amit K Mahajan2, Catherine L Oberg3, Fabien Maldonado4, Eric Toloza5, William S Krimsky6, Scott Oh3, Mark R Bowling7, Sadia Benzaquen8, Charles M Kinsey9, Atul C Mehta10, Sebastian Fernandez-Bussy11, Javier Flandes12, Kelvin Lau13, Ganesh Krishna14, Michael A Nead15, Felix Herth16, Alejandro A Aragaki-Nakahodo8, Emanuela Barisione17, Sandeep Bansal18, Dragos Zanchi19, Michael Zgoda20, Peter O Lutz21, Robert J Lentz4, Christopher Parks22, Mario Salio23, Kenneth Perret24, Colleen Keyes25, Gregory P LeMense26, John D Hinze27, Adnan Majid28, Merete Christensen29, Jordan Kazakov30, Gonzalo Labarca31, Ernest Waller26, Michael Studnicka32, Catalina V Teba33, Sandeep J Khandhar34. 1. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA. Electronic address: efolch@mgh.harvard.edu. 2. INOVA Medical Group, Falls Church, VA. 3. Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA. 4. Vanderbilt University Medical Center, Nashville, TN. 5. Moffitt Cancer Center, Tampa, FL. 6. MedStar Franklin Square Medical Center, Baltimore, MD. 7. Division of Pulmonary, Critical Care, and Sleep Medicine, East Carolina University, Greenville, NC. 8. University of Cincinnati, Cincinnati, OH. 9. University of Vermont, Burlington, VT. 10. Cleveland Clinic Health System, Cleveland, OH. 11. Mayo Clinic Hospital Jacksonville, Jacksonville, FL. 12. Interventional Pulmonology Service, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain. 13. Barts Health NHS Trust, London, England. 14. Palo Alto Medical Foundation, Palo Alto, CA. 15. University of Rochester, Rochester, NY. 16. Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany. 17. Interventional Pulmonology Unit, IRCCS San Martino Hospital-IST National Cancer Research Institute, Genoa, Italy. 18. Lancaster General Hospital, Lancaster, PA. 19. Pulmonary and Sleep of Tampa Bay Inc, Wesley Chapel, FL. 20. University Pulmonary Associates, Charlotte, NC. 21. Pulmonary Associates of Mobile, Daphne, AL. 22. Cancer Treatment Centers of America, Atlanta, GA. 23. IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 24. Shannon Medical Center, San Angelo, TX. 25. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA. 26. Blount Memorial Hospital, Maryville, TN. 27. Seton Healthcare Family, Austin, TX. 28. Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA. 29. Rigshospitalet, Copenhagen, Denmark. 30. Brigham and Women's Hospital, Boston, MA. 31. Department of Internal Medicine, Pontifical Catholic University, Santiago, Chile. 32. Department of Pulmonary Medicine, the Paracelsus Medical University, Salzburg, Austria. 33. University Hospitals of Cleveland, Cleveland, OH. 34. Virginia Cancer Specialists PC, Fairfax, VA.
Abstract
BACKGROUND: Transbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created? METHODS: Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first. RESULTS: Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale. CONCLUSIONS: The use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.
BACKGROUND: Transbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created? METHODS: Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first. RESULTS: Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale. CONCLUSIONS: The use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.
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