title: Trauma-associated pneumonia in adult ventilated patients.
abstract: BACKGROUND
  The clinical pulmonary infection score (CPIS) and bronchoalveolar lavage (BAL) are 2 tools that have been validated to diagnose pneumonia in critically ill patients. However, the role of the CPIS in diagnosing trauma-associated pneumonia (TAP) remains in question.
  
  
  METHODS
  This prospective observational study included all trauma patients who were ventilated for longer than 48 hours from September 2008 to September 2009. The CPIS and quantitative culture results from the BAL were collected and used to define pneumonia.
  
  
  RESULTS
  A total of 162 patients were identified. In all, 58 (35.8%) and 104 (64.2%) had a CPIS greater than 5 and a CPIS of 5 or less, respectively. There were 95 (58.6%) patients who had a BAL completed regardless of CPIS. There were 65 patients who met the bacteriologic definition of pneumonia (≥10(4) colonies/mL), for an overall TAP incidence of 40.1%.
  
  
  CONCLUSIONS
  The CPIS is unreliable as a clinical tool to predict a positive BAL at 10(4) or 10(5) or higher threshold. Therefore, BAL should be used for the diagnosis of TAP based on clinical rationale and not the CPIS.
authors.affiliation: Department of Trauma, Department of General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA. patelcmd@gmail.com
authors.forename: Chirag B
authors.initials: CB
authors.lastname: Patel
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gillespie
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Goslar
authors.forename: Maughan
authors.initials: M
authors.lastname: Sindhwani
authors.forename: Scott R
authors.initials: SR
authors.lastname: Petersen
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018893:Bronchoalveolar Lavage; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult