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Respiratory severity score for infants and young children with bronchiolitis

Respiratory severity score for infants and young children with bronchiolitis
Parameter* Points Score
Respiratory rate

For infants ≤2 months of age: <60 bpm

For infants 3 to <12 months: <50 bpm

For children 12 to 24 months: <40 bpm
1  

For infants <2 months of age: 60 to 69 bpm

For infants 2 to <12 months: 50 to 59 bpm

For children 12 to 24 months: 40 to 49 bpm
2  

For infants <2 months of age: ≥70 bpm

For infants 2 to <12 months: ≥60 bpm

For children 12 to 24 months: ≥50 bpm
3  
Respiratory effort
Normal 0  
Mild subcostal or intercostal retractions 1  
Moderate subcostal, intercostal, and/or substernal retractions with or without nasal flaring but no grunting or head bobbing 2  
Severe subcostal, intercostal, and/or suprasternal retractions; grunting and flaring; head bobbing 3  
Lung examination
Good aeration, normal breath sounds 0  
Scattered wheezes and/or rhonchi, good lung aeration 1  
Diffuse wheezes and/or rhonchi, prolonged exhalation, decreased aeration 2  
Poor lung aeration 3  
Activity level and feeding
Normal activity, feeding, and vocalization 0  
Some fussiness and difficulty feeding, but consoles easily 1  
Agitated, poor feeding, decreased vocalization 2  
Lethargic, not able to feed, not vocalizing 3  
Total (maximum score 12)  
Interpretation
Mild 1 to 4
Moderate 5 to 8
Severe 9 to 12
This table summarizes the components and the interpretation of the RSS, which is used to assess severity of symptoms in infants and young children with bronchiolitis. Repeated observations are necessary to adequately assess disease severity because examination findings may vary substantially over time. Refer to UpToDate's topics on bronchiolitis for additional details.

bpm: breaths per minute; RSS: respiratory severity score.

* While not included in the RSS, the presence of apnea signals severe illness. Apnea is most common in preterm infants and infants <2 months old.
Graphic 143449 Version 1.0

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