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

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.545-550
• Main Authors: da Silva, Paulo Sérgio Lucas, MD, MsC, de Aguiar, Vânia Euzébio, MsC, de Carvalho, Werther Brunow, MD, PhD, Machado Fonseca, Marcelo Cunio, MD, MsC
• Format: Article
• Language: English
• Subjects: Area Under Curve; Child, Preschool; Clinical pulmonary infection score; Critical Care; Critical Illness; Diagnostic Techniques, Respiratory System; Female; Fever; Hospitals; Humans; Infant; Male; Mechanical ventilation; Mortality; Nosocomial infections; Pediatric; Pneumonia; Pneumonia, Ventilator-Associated - diagnosis; Predictive Value of Tests; Prospective Studies; Respiration, Artificial - utilization; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; United States; Ventilator-associated pneumonia; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.01.010

Abstract 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.