Bronchiolitis severity score

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: BSS


The bronchiolitis severity score (BSS) is an assessment scale used to evaluate the severity of illness in infants.

Historical Perspective

The BSS was developed in 1992 to assess the relationship between the total bronchiolitis severity score and the arterial oxygen saturation in children with bronchiolitis.[1]

Data Source for Derivation and Validation

The BSS was tested for reliability by two of the original investigators. The investigators reported kappa of the individual components of the score:

  • General assessment: Kappa was 0.48
  • Respiratory rate: Kappa was 0.38
  • Wheezing: Kappa was 0.31
  • Retractions: Kappa was 0.25

Alternative Scales

Alternative severity scales include:

  • Court's scale: This scale includes respiratory rate and assessments of retractions, adventitial sounds, skin color, and general condition.[2]
  • Respiratory distress observation scale (RDOS)[3]: This scale includes the scores of four findings on a scale ranging from 0 to 3 so that total scores range from 0 to 12.
  • Tal and modified-Tal scoring systems[4]

The Instrument

Score Respiratory Rate Wheezing Retraction General Condition
0 <30 None None Normal
1 30–45 Terminal expiration or only with stethoscope Intercostal
2 46–60 Entire expiration or audible on expiration without stethoscope Tracheosternal
3 >60 Inspiration and expiration without stethoscope Irritability, lethargy, poor feeding


  1. Wang EE, Milner RA, Navas L, Maj H (1992). "Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections". Am Rev Respir Dis. 145 (1): 106–9. doi:10.1164/ajrccm/145.1.106. PMID 1731571.
  2. Court SD (1973). "The definition of acute respiratory illnesses in children". Postgrad Med J. 49 (577): 771–6. PMC 2495839. PMID 4806395.
  3. Campbell ML (2008). "Psychometric testing of a respiratory distress observation scale". J Palliat Med. 11 (1): 44–50. doi:10.1089/jpm.2007.0090. PMID 18370892.
  4. McCallum GB, Morris PS, Wilson CC, Versteegh LA, Ward LM, Chatfield MD; et al. (2013). "Severity scoring systems: are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?". Pediatr Pulmonol. 48 (8): 797–803. doi:10.1002/ppul.22627. PMID 22949369.