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Standardized definitions of bleeding after transbronchial lung biopsy: a Delphi Consensus Statement from the Nashville Working Group

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 w...

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Main Authors: Folch, Erik E. (Author) , Mahajan, Amit K. (Author) , Oberg, Catherine L. (Author) , Maldonado, Fabien (Author) , Toloza, Eric (Author) , Krimsky, William S. (Author) , Oh, Scott (Author) , Bowling, Mark R. (Author) , Benzaquen, Sadia (Author) , Kinsey, Charles M. (Author) , Mehta, Atul C. (Author) , Fernandez-Bussy, Sebastian (Author) , Flandes, Javier (Author) , Lau, Kelvin (Author) , Krishna, Ganesh (Author) , Nead, Michael A. (Author) , Herth, Felix (Author) , Aragaki-Nakahodo, Alejandro A. (Author) , Barisione, Emanuela (Author) , Bansal, Sandeep (Author) , Zanchi, Dragos (Author) , Zgoda, Michael (Author) , Lutz, Peter O. (Author) , Lentz, Robert J. (Author) , Parks, Christopher (Author) , Salio, Mario (Author) , Perret, Kenneth (Author) , Keyes, Colleen (Author) , LeMense, Gregory P. (Author) , Hinze, John D. (Author) , Majid, Adnan (Author) , Christensen, Merete (Author) , Kazakov, Jordan (Author) , Labarca, Gonzalo (Author) , Waller, Ernest (Author) , Studnicka, Michael (Author) , Teba, Catalina V. (Author) , Khandhar, Sandeep J. (Author)
Format: Article (Journal)
Language:English
Published: 14 February 2020
In: Chest
Year: 2020, Volume: 158, Issue: 1, Pages: 393-400
ISSN:1931-3543
DOI:10.1016/j.chest.2020.01.036
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.chest.2020.01.036
Verlag, lizenzpflichtig, Volltext: https://journal.chestnet.org/article/S0012-3692(20)30272-5/abstract
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Author Notes:Erik E. Folch, MD; Amit K. Mahajan, MD; Catherine L. Oberg, MD; Fabien Maldonado, MD; Eric Toloza, MD, PhD; William S. Krimsky, MD; Scott Oh, DO; Mark R. Bowling, MD; Sadia Benzaquen, MD; Charles M. Kinsey, MD; Atul C. Mehta, MD; Sebastian Fernandez-Bussy, MD; Javier Flandes, MD, PhD; Kelvin Lau, MD; Ganesh Krishna, MD; Michael A. Nead, MD, PhD; Felix Herth, MD, PhD; Alejandro A. Aragaki-Nakahodo, MD; Emanuela Barisione, MD; Sandeep Bansal, MD; Dragos Zanchi, MD; Michael Zgoda, MD; Peter O. Lutz, MD; Robert J. Lentz, MD; Christopher Parks, MD; Mario Salio, MD; Kenneth Perret, MD; Colleen Keyes, MD; Gregory P. LeMense, MD; John D. Hinze, DO; Adnan Majid, MD; Merete Christensen, MD; Jordan Kazakov, MD; Gonzalo Labarca, MD; Ernest Waller, MD; Michael Studnicka, MD; Catalina V. Teba, MD, and Sandeep J. Khandhar, MD

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520 |a 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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