Diagnostic yield of flexible bronchoscopy and bronchoalveolar lavage in children with chronic cough.
Bibliographic record
Abstract
Introduction: Chronic cough is defined as a daily cough lasting more than 4 weeks. Flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) allows for detailed airway assessment, BAL fluid analysis and microbiological studies. It is recommended in the current diagnostic pathway for unexplained chronic cough. Objectives: This study aimed to describe clinical features, FB and BAL findings in children with chronic cough. Methods: Retrospective review of children who underwent FB and BAL for chronic cough or a history of more than 3 episodes of chronic wet cough in a single centre in South Africa between 2015 to 2021. Results: 77 patients (mean age 5.1) were included. 21 (27%) patients had more than 3 episodes of chronic cough in 12 months. Clinical features included wet cough (83%), wheeze (61%), atopy (16%) and chronic inhaled corticosteroid use (60%). 20 (26%) patients had lower airway anatomical abnormalities. 57% and 16% had an increased neutrophil and eosinophil % in BAL fluid (BALf) respectively. In 45% at least one bacteria was isolated and 37% had at least one positive viral PCR. The most common bacteria were H. influenzae (26%), S. pneumoniae (10%) and M. catarrhalis (8%). Mycobacterial cultures were negative. The BALf neutrophil % was correlated with a positive bacterial culture (p=0.002). Eosinophilic inflammation in BALf was associated with blood eosinophilia (p=0.044). Conclusion: Flexible bronchoscopy identified an anatomical airway abnormality in a quarter of all patients. A BALf neutrophil percentage >5% is strongly correlated with bacterial infection. These findings support the current guidelines for the role of flexible bronchoscopy and BAL in chronic cough.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".