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Published ahead of print on May 8, 2003, doi:10.1164/rccm.200212-1449OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 2, July 2003, 173-179

A more recent version of this article appeared on July 15, 2003
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Submitted on December 12, 2002
Accepted on May 4, 2003

Diagnosing pneumonia during mechanical ventilation: The Clinical Pulmonary Infection Score revisited

Muriel Fartoukh1, Bernard Maitre2, Stephanie Honore3, Charles Cerf4, Jean-Ralph Zahar1, and Christian Brun-Buisson1*

1 Reanimation Medicale, Hopital Henri Mondor, Creteil, France, 2 Antenne de Pneumologie, Hopital Henri Mondor, Creteil, France, 3 Service de Microbiologie, Hopital Henri Mondor, Creteil, France, 4 Reanimation Chirurgicale, Hopital Henri Mondor, Creteil, France

* To whom correspondence should be addressed. E-mail: christian.brun-buisson{at}hmn.ap-hop-paris.fr.

The clinical pulmonary infection score (CPIS) - original or modified - has been proposed for the diagnosis and management of ventilator-associated pneumonia. In 79 episodes of suspected pneumonia, we prospectively assessed the diagnostic accuracy of the physicians' clinical assessment of probability and of the modified clinical pulmonary infection score, both measured before (pre-test) and after (post-test) incorporating Gram stains results, using broncho-alveolar lavage fluid culture as the reference test. The pre-test clinical estimate was inaccurate (sensitivity [Se] 50%, specificity [Sp] 58%); the mean clinical pulmonary infection score at baseline was 6.5 ±1.3 (range, 3 to 9) and 5.9 ±1.7 (range 3 to 9), respectively for the 40 confirmed and the 39 non-confirmed episodes (p=0.07), and only slightly more accurate (Se 60%; Sp 59%) than the clinical prediction. Incorporating the Gram stains results of either directed or blind protected sampling increased the diagnostic accuracy (Se and Sp of 85% and 49% and 78% and 56%, respectively) of the clinical score and increased the likelihood ratio for pneumonia of a score >6 from 1.46 to 1.67 and 1.77. The clinical pulmonary infection score has low diagnostic accuracy; however, incorporating Gram stains results into the score may help clinical-decision making in patients with clinically suspected pneumonia.
Key words: Key words: Pneumonia, hospital infection, clinical diagnosis, mechanical ventilation




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