Validation of a Clinical Instrument for Measuring the Severity of Acute Bronchitis in Children – The BSS-ped

Siegfried Lehrl1, Peter Kardos2, Heinrich Matthys3, Wolfgang Kamin4, *
1 Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
2 Group Practice and Centre for Pneumology, Center for Respiratory, Allergy and Sleep Medicine at Red Cross Maingau Hospital, Frankfurt am Main, Germany
3 Department of Pneumology, University Hospital Freiburg, Freiburg, Germany
4 Clinic for Paediatrics, Evangelic Hospital Hamm, Hamm, Germany

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© 2018 Lehrl et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Clinic for Paediatrics, Evangelic Hospital Hamm, Werler Straße 130, 59063 Hamm, Germany; Tel: 49 2381 589 3476; Fax: 49 2381 589 3477; E-mail:



There are no validated standardised clinical procedures for severity measurement of acute bronchitis in children. The “BSS-ped”, a short version of the physician-rated assessment scale BSS (Bronchitis Severity Scale), can fill this gap, if it is valid.


To examine the scale´s validity.


Investigations were planned according to classical clinical-psychometric validity criteria including a formal competence evaluation of the scale´s authors and statistical analyses of data from 78 patients aged 1-6 and diagnosed with “acute bronchitis”. Cross-validation was provided by analysis of data from 70 children with matching age, sex and diagnosis. All children were examined three times (day 0, 3-5 and 7) using the BSS-ped in addition to other clinical and psychometric monitoring procedures.


The evidently high level of expertise of the scale’s authors substantiates pronounced content validity and relevance of the BSS-ped and its items. The validity criterion, i.e. to reflect the unidimensional severity of acute bronchitis and its change using the BSS-ped score, was fulfilled. There were substantial correlations with other scales measuring the current health-related quality of life, as well as satisfaction and success of treatment. Severity change prognoses for acute bronchitis under placebo and an active substance were correct. The BSS-ped was found to be a feasible instrument because it can be repeated at short intervals (minute range) without any special technical aids or extended training.


The BSS-ped is a valid procedure for measuring the severity of acute bronchitis in children.

Keywords: Acute bronchitis, Bronchitis severity scale, Clinical psychometry, Outcome assessment, Severity of illness index, Validation.