Clinical Pulmonary Infection Score to diagnose ventilator-associated pneumonia in children.

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(4) cfu/mL was considered reference standard for definite VAP. RESULTS Of the five variables used for simplified CPIS, only patients temperature (P=0.013) and PaO2/FiO2 ratio were significant (P<0.001) to differentiate the presence of definite VAP. Patients with definite VAP (BAL colony count = 10(4) cfu/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.