title: The clinical pulmonary infection score poorly predicts pneumonia in patients with burns.
abstract: The Clinical Pulmonary Infection Score (CPIS) has been reported to be a useful tool in the diagnosis of ventilator-associated pneumonia (VAP) in the critical care setting. However, the systemic inflammation associated with injury may limit the utility of CPIS in patients with burns. The purpose of this study was to determine the potential utility of CPIS in the management of burn patients. A retrospective review was performed on all burn patients who underwent quantitative culture to diagnose VAP from 2003 to 2005. CPIS was retrospectively calculated for each patient on the day of the procedure. The sensitivity, specificity, and predictive values of a CPIS greater than 6 for VAP diagnosis were calculated. In addition, CPIS scores of patients with and without pneumonia were compared using the Mann-Whitney U test. A total of 46 quantitative cultures were obtained in 28 patients during the study period. Average patient age was 45 +/- 19 years, average TBSA was 33 +/- 18%, and the average APACHE II score on admission was 16 +/- 6. Sixty-eight percent of patients had inhalation injury. Twenty-six quantitative cultures were positive, and 20 were negative. Mean CPIS was 5.7 for patients with negative quantitative cultures and 5.5 for patients with positive cultures (P = .41). The sensitivity of CPIS scoring was 0.3, and its specificity was 0.8. CPIS had a positive predictive value of 0.7 and negative predictive value of 0.5. CPIS--a reported reliable indicator of VAP in critically ill patients--did not accurately predict the presence of pneumonia in burn patients. VAP diagnosis in burn patients should still rely on clinical suspicion verified by quantitative culture.
authors.affiliation: Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA.
authors.forename: Tam N
authors.initials: TN
authors.lastname: Pham
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Neff
authors.forename: Jillian M
authors.initials: JM
authors.lastname: Simmons
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
authors.forename: David M
authors.initials: DM
authors.lastname: Heimbach
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D002053:Burn Units; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index