Diagnosing pneumonia during mechanical ventilation -: The clinical pulmonary infection score revisited
Diagnosing pneumonia during mechanical ventilation -: The clinical pulmonary infection score revisited
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DOI：
10.1164/rccm.200212-1449oc
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发表时间：
2003-07-15
影响因子：
24.7
通讯作者：
Brun-Buisson, C
中科院分区：
文献类型：
--
作者：
Fartoukh, M;Maître, B;Brun-Buisson, C
临床肺部感染评分--原始的或修改的--已被建议用于呼吸机相关性肺炎的诊断和治疗。在79例疑似肺炎病例中，我们以支气管肺泡灌洗液培养为参照物，前瞻性地评估了医生临床概率评估和改良临床肺部感染评分的诊断准确性，包括检测前(检测前)和检测后(检测后)的革兰氏染色结果。试验前的临床评估是不准确的(敏感度50%，特异度58%)；基线的平均临床肺部感染评分分别为6.5+/-1.3(范围3-9)和5.9+/-1.7(范围3-9)(p=0.07)，仅略高于临床预测(敏感度60%，特异度59%)。采用直接或盲法保护抽样的革兰氏染色结果提高了临床评分的诊断准确性(敏感性和特异性分别为85%和49%，78%和56%)，并将肺炎评分大于6分的似然比从1.46增加到1.67和1.77。临床肺部感染评分诊断准确率较低；然而，将革兰氏染色结果纳入评分可能有助于临床疑似肺炎患者的临床决策。
The clinical pulmonary infection score-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 (pretest) and after (post-test) incorporating gram stains results, using bronchoalveolar lavage fluid culture as the reference test. The pretest clinical estimate was inaccurate (sensitivity 50%, specificity 58%); the mean clinical pulmonary infection score at baseline was 6.5 +/- 1.3 (range, 3-9) and 5.9 +/- 1.7 (range, 3-9), respectively, for the 40 confirmed and the 39 nonconfirmed episodes (p = 0.07), and only slightly more accurate (sensitivity 60%, specificity 59%) than the clinical prediction. Incorporating the gram stain results of either directed or blind protected sampling increased the diagnostic accuracy (sensitivity and specificity of 85% and 49% and 78% and 56%, respectively) of the clinical score and increased the likelihood ratio for pneumonia of a score of more than six 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.