Validity of bronchoscopist assessment of patient discomfort during flexible bronchoscopy: an observational study

Abstract The distress experienced by patients during bronchoscopy is often more severe than bronchoscopists anticipate. We examined the accuracy of bronchoscopist evaluation of predicted patient discomfort during bronchoscopy under intravenous sedation. This study retrospectively reviewed 186 consecutive patients who underwent bronchoscopy between December 2018 and April 2019. Ultimately, 113 patients who underwent bronchoscopy with pethidine and 64 patients who underwent bronchoscopy with pethidine and midazolam were assigned to the pethidine group and pethidine with midazolam combination group, respectively. We compared the patient discomfort score obtained by self-assessment with the patient discomfort score predictively evaluated by bronchoscopists using a 5-point rating scale in each sedation group. Any discrepancy was then evaluated. The pethidine group had significantly higher self-assessed patient discomfort scores than the predictive assessment by bronchoscopists [mean score 3.4±1.3 vs. 2.9±1.2; P < 0.0001]. Conversely, the pethidine with midazolam group had significantly lower self-assessed patient discomfort score than the bronchoscopists’ predictive assessment [mean score 2.4±1.5 vs. 3.3±1.4; P = 0.0004]. Multivariate analysis identified the use of midazolam as a significant factor affecting patient discomfort (odds ratio: 0.176, P < 0.001). Bronchoscopists may underestimate patient discomfort during bronchoscopy under intravenous sedation. The use of midazolam in combination with pethidine relieved patient discomfort.