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. 2020 Jul;158(1):393-400.
doi: 10.1016/j.chest.2020.01.036. Epub 2020 Feb 14.

Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group

Erik E Folch  1 , Amit K Mahajan  2 , Catherine L Oberg  3 , Fabien Maldonado  4 , Eric Toloza  5 , William S Krimsky  6 , Scott Oh  3 , Mark R Bowling  7 , Sadia Benzaquen  8 , Charles M Kinsey  9 , Atul C Mehta  10 , Sebastian Fernandez-Bussy  11 , Javier Flandes  12 , Kelvin Lau  13 , Ganesh Krishna  14 , Michael A Nead  15 , Felix Herth  16 , Alejandro A Aragaki-Nakahodo  8 , Emanuela Barisione  17 , Sandeep Bansal  18 , Dragos Zanchi  19 , Michael Zgoda  20 , Peter O Lutz  21 , Robert J Lentz  4 , Christopher Parks  22 , Mario Salio  23 , Kenneth Perret  24 , Colleen Keyes  25 , Gregory P LeMense  26 , John D Hinze  27 , Adnan Majid  28 , Merete Christensen  29 , Jordan Kazakov  30 , Gonzalo Labarca  31 , Ernest Waller  26 , Michael Studnicka  32 , Catalina V Teba  33 , Sandeep J Khandhar  34
Affiliations

Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group

Erik E Folch et al. Chest. 2020 Jul.

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.

Keywords: biopsy (lung); bleeding; bronchoscopy; interventional bronchoscopy.

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Figures

Figure 1
Figure 1
Flow chart of Delphi method and consensus.
Figure 2
Figure 2
Survey data assessing which variables are necessary to estimate bleeding severity after transbronchial biopsy.
Figure 3
Figure 3
Satisfaction with proposed bleeding scale using Delphi method.
Figure 4
Figure 4
Survey data regarding the applicability of the proposed scale to other bronchoscopic procedures. EBUS = endobronchial ultrasound; TBLB = transbronchial lung biopsy.
Figure 5
Figure 5
Proposed scale for assessing severity of bleeding during transbronchial biopsy.
See this image and copyright information in PMC

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