Standardized bleeding definitions after transbronchial lung biopsy: a Delphi consensus statement from the Nashville Working Group

Abstract Background Transbronchial lung biopsies are commonly performed for a variety of indications. While generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for; this purpose. Research Question Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created? Study Design and Methods: Using the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity for patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching >80% consensus among the experts or three rounds, whichever occurred first. Results Thirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and propose the Nashville Bleeding Scale.