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 4cfu/mL was considered reference standard for definite VAP. Results: Of the five variables used for simplified CPIS, only patient's temperature (P=0.013) and PaO 2/FiO 2 ratio were significant (P<0.001) to differentiate the presence of definite VAP. Patients with definite VAP (BAL colony count ≥10 4cfu/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. © 2011 Indian Academy of Pediatrics.