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

Folch EK, Mahajan AK et al

CHEST Volume 158, Number 1, 2020, Pages 393-400


What is the key question?

  • Transbronchial lung biopsies are performed for several different diagnostic indications. Bleeding occurs during these procedures but the description of severity is largely subjective and has been difficult to standardize. This paper brought together 36 bronchoscopists to create a consensus definition of bleeding severity associated with transbronchial lung biopsy.

What is the bottom line?

  • This group used expert opinion and subsequent literature review to generate a list of features that were considered significant indicators associated with procedural bleeding at transbronchial lung biopsy
  • The group used a modified Delphi methodology, requiring >80% agreement between panel members, to develop an airway bleeding scale which can be applied at the bedside to more definitively categorize the severity of bleeding at TBLB.

Why read on?

  • There is considerable variability in estimates of bleeding associated with lung biopsy. This scale is the first to attempt to make bleeding estimates consistent and reproducible between observers. The Nashville Bleeding Scale is presented in this paper, based on the groups consensus.
  • While disagreement with any scoring system will continue, this scale brings a framework for consistency in defining procedure related bleeding which has not previously been suggested.