The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia
| Autor: | Daren K. Heyland, Peter Dodek, Andrew F. Shorr, Andrew G. Day, François Lauzier, Xuran Jiang, Annie Ruest, Deborah J. Cook, Martin Albert |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Critical Care and Intensive Care Medicine Sensitivity and Specificity law.invention Diagnosis Differential Randomized controlled trial Predictive Value of Tests law Internal medicine medicine Humans Probability Analysis of Variance Chi-Square Distribution Receiver operating characteristic business.industry Ventilator-associated pneumonia Pneumonia Ventilator-Associated Middle Aged medicine.disease Confidence interval Anti-Bacterial Agents Surgery Pre- and post-test probability Intensive Care Units Pneumonia ROC Curve Predictive value of tests Female business Chi-squared distribution |
| Zdroj: | Journal of Critical Care. 23:50-57 |
| ISSN: | 0883-9441 |
| Popis: | Purpose The aim of the study was to assess the utility of pretest probability and modified clinical pulmonary infection score CPIS in the diagnosis of late-onset ventilator-associated pneumonia (VAP). Materials and Methods In 740 adults enrolled in a multicenter randomized trial, intensivists prospectively rated the pretest probability of VAP as low, moderate, or high based on their clinical judgment. The modified CPIS was calculated without considering culture results. Ventilator-associated pneumonia diagnosis was determined by 2 adjudicators using standardized definitions. We analyzed the relationship between pretest likelihood, CPIS, and VAP diagnosis. Results Among the 739 patients analyzed, 14.5%, 39.6%, and 45.9% had low, moderate, and high pretest probability of VAP. Patients with high pretest probability had a lower PaO 2 /FiO 2 ratio and a larger volume of secretions. High or moderate vs low pretest probability had high sensitivity (0.88; 95% confidence interval [CI], 0.87-0.89) and positive predictive value (0.87; 95% CI, 0.86-0.88) but low specificity (0.27; 95% CI, 0.21-0.35) and negative predictive value (0.29; 95% C,: 0.22-0.37) for the diagnosis of VAP. Therefore, 71% of patients who had a low pretest probability were actually infected (1 − negative predictive value). The area under the receiver operating characteristic curve for the modified CPIS was not significant (0.47; 95% CI, 0.42-0.53), meaning that no score threshold was clinically useful. Conclusions Pretest probability and a modified CPIS, which excludes culture results, are of limited utility in the diagnosis of late-onset VAP. |
| Databáze: | OpenAIRE |
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