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Intensive Care Medicine

, Volume 30, Issue 2, pp 217–224 | Cite as

Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability

  • Carolina A. M. SchurinkEmail author
  • Christianne A. Van Nieuwenhoven
  • Jan A. Jacobs
  • Maja Rozenberg-Arska
  • Hans C. A. Joore
  • Erik Buskens
  • Andy I. M. Hoepelman
  • Marc J. M. Bonten
Original

Abstract

Objective

Although quantitative microbiological cultures of samples obtained by bronchoscopy are considered the most specific tool for diagnosing ventilator-associated pneumonia, this labor-intensive invasive technique is not widely used. The Clinical Pulmonary Infection Score (CPIS), a diagnostic algorithm that relies on easily available clinical, radiographic, and microbiological criteria, could be an attractive alternative for diagnosing ventilator-associated pneumonia. Initially, the CPIS scoring system was validated upon 40 quantitative cultures of bronchoalveolar lavage fluid from 28 patients, and only few other studies have evaluated this scoring system since then. Therefore, little is known about the accuracy of this score.

Design

We compared the scores of a slightly adjusted CPIS with results from quantitative cultures of bronchoalveolar lavage fluid in 99 consecutive patients with suspicion of ventilator-associated pneumonia, using growth of ≥104 cfu/ml in bronchoalveolar lavage fluid as a cut-off for diagnosing ventilator-associated pneumonia. In addition, the CPIS were calculated for 52 patients by two different intensivists to determine the inter-observer variability.

Results

Ventilator-associated pneumonia was diagnosed in 69 (69.6%) patients. When using a CPIS >5 as diagnostic cutoff, the sensitivity of the score was 83% and its specificity was 17%. The area under the Receiver Operating Characteristic curve was 0.55. The level of agreement for prospectively measured Clinical Pulmonary Infection Score (≤6 and >6) was poor (kappa =0.16).

Conclusions

When compared to quantitative cultures of bronchoalveolar lavage fluid, the CPIS has a low sensitivity and specificity for diagnosing ventilator-associated pneumonia with considerable inter-observer variability.

Keywords

Clinical pulmonary infection score Ventilator-associated pneumonia Intensive care unit Inter-observer variability Diagnosis 

Notes

Acknowledgement

We are indebted to our ICU physicians for scoring CPIS and A. Jager for her help with logistic regression analysis.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Carolina A. M. Schurink
    • 1
    Email author
  • Christianne A. Van Nieuwenhoven
    • 1
  • Jan A. Jacobs
    • 1
  • Maja Rozenberg-Arska
    • 1
  • Hans C. A. Joore
    • 1
  • Erik Buskens
    • 1
  • Andy I. M. Hoepelman
    • 1
  • Marc J. M. Bonten
    • 1
  1. 1.Department of Medicine, Division of Acute Medicine and Infectious Diseases, Eijkman-Winkler Laboratory for Microbiology Julius Centre for Health Sciences and Primary Health Care, University Hospital Maastricht, University Medical Centre Utrecht and Department of Medical MicrobiologyUtrechtThe Netherlands

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