Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia

Date
2014-08-01Author
Lucas da Silva, Paulo Sergio
Aguiar, Vania Euzebio de
Carvalho, Werther Brunow de
Machado Fonseca, Marcelo Cunio [UNIFESP]
Type
ArtigoISSN
0883-9441Is part of
Journal of Critical CareDOI
10.1016/j.jcrc.2014.01.010Metadata
Show full item recordAbstract
Rationale: Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP).Methods: Seventy children were prospectively included if they fulfilled the diagnosis criteria for VAP referenced by the Centers for Disease Control and Prevention. the primary outcome was performance of mCPIS calculated on day 1 to accurately identify VAP as defined by microbiological data.Results: the data showed that an mCPIS of 6 or higher had a sensitivity of 94%, specificity of 50%, positive predictive value of 64%, negative predictive value of 90%, a positive likelihood ratio of 1.88, and a negative likelihood ratio of 0.11. the area under the receiver operating characteristic curve was 0.70. A positive posttest result increased the disease probability by 15.4%, whereas a negative test result reduced the probability by 38.6%. Patients with an mCPIS of 6 or higher had longer length of mechanical ventilation and pediatric intensive care unit stay compared with patients with an mCPIS lower than 6.Conclusion: the mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions. (C) 2014 Elsevier Inc. All rights reserved.
Citation
Journal of Critical Care. Philadelphia: W B Saunders Co-Elsevier Inc, v. 29, n. 4, p. 545-550, 2014.Keywords
Clinical pulmonary infection scoreMechanical ventilation
Pediatric
Ventilator-associated pneumonia
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