Paulo Sérgio Lucas da Silva1, Vânia Euzébio de Aguiar2, Werther Brunow de Carvalho3, Marcelo Cunio Machado Fonseca4. 1. Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. Electronic address: psls.nat@terra.com.br. 2. Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. 3. Pediatric Intensive Care Unit and Department of Neonatology, Universidade de São Paulo, São Paulo, Brazil; Children's Institute, Faculty of Medicine Clinics Hospital, University of São Paulo, São Paulo, Brazil. 4. Department of Pediatrics, Pediatric Intensive Care Unit, Universidade Federal de São Paulo, São Paulo, Brazil.
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.
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.
Authors: John Alexander Clark; Iain Robert Louis Kean; Martin D Curran; Fahad Khokhar; Deborah White; Esther Daubney; Andrew Conway Morris; Vilas Navapurkar; Josefin Bartholdson Scott; Mailis Maes; Rachel Bousfield; Theodore Gouliouris; Shruti Agrawal; David Inwald; Zhenguang Zhang; M Estée Török; Stephen Baker; Nazima Pathan Journal: BMJ Open Date: 2021-11-29 Impact factor: 2.692