Expanding a Bronchoscopic Scoring Tool to Children with Cystic Fibrosis: Inter-Rater Reliability of Novel Features

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Background: Flexible bronchoscopy (FB) is a vital tool for assessing lung disease in pediatric patients. The widely used FB scoring system proposed by Thomas et al. [1] does not fully capture all airway changes in patients with cystic fibrosis (CF), highlighting the need for additional features. Methods: We expanded the FB scoring system by adding four new CF-relevant features: secretion viscosity, bleeding, vascular drawing, and mucus plugging. The revised system was tested on 80 FB recordings (50 CF, 30 non-CF; mean age 8.1 ± 4.8 years). Four independent examiners (one senior consultant, two senior residents, and one student) evaluated the recordings. Inter-rater reliability was assessed using Gwet's AC2 coefficient. Results: The revised FB scoring system demonstrated inter-rater reliability comparable to that reported by Thomas et al. [1]. Among the newly introduced features, agreement was almost perfect for mucus plugging (0.94 CI: 0.90–0.97) and substantial for bleeding (0.80 CI: 0.72–0.89). Moderate agreement was observed for vascular drawing (0.50 CI: 0.41–0.59) and secretion viscosity (0.47 CI: 0.35–0.59). Conclusion: Our findings validate the inter-rater reliability of the revised Thomas FB scoring system, which incorporates four additional features for improved airway assessment in pediatric patients. Further studies are needed to evaluate the clinical utility of this expanded scoring system. References 1. Thomas RJ, Eg KP, Masters IB, McElrea M, Chang AB. Towards developing a valid scoring tool for bronchitis during flexible bronchoscopy. Pediatr Pulmonol. 2018;53: 1510–1516.

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