Clinical Pulmonary Infection Score to diagnose ventilator-associated pneumonia in children

Abstract

Background: There is a need to validate and suggest easy clinical method for diagnosis of ventilator-associated pneumonia (VAP) in developing countries.

Objectives: To validate the use of simplified Clinical Pulmonary Infection Score (CPIS) for the diagnosis of VAP.

Design: Prospective study.

Setting: Pediatric intensive care unit of a tertiary care teaching hospital.

Subjects: 30 children receiving mechanical ventilation for more than 48 hours and with simplified CPIS=6.

Methods: All patients underwent flexible bronchoscopy to obtain bronchoalveolar lavage which was analyzed quantitatively. Colony count = 10(4) cfu/mL was considered reference standard for definite VAP.

Results: Of the five variables used for simplified CPIS, only patients temperature (P=0.013) and PaO2/FiO2 ratio were significant (P<0.001) to differentiate the presence of definite VAP. Patients with definite VAP (BAL colony count = 10(4) cfu/mL) had CPIS of 8.4 while in no definite VAP group it was 6.4 (P=0.007). CPIS of 8 was found to have sensitivity of 80%, specificity 80%, PPV 86.9%, NPV 70.5% and accuracy 80%. The area under Receiver operating characteristic curve of CPIS against reference standard was 0.81± 0.069 (P=0.001).

Conclusion: Simplified CPIS is useful in patients on mechanical ventilation to diagnose ventilator-associated pneumonia.