title: Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia.
abstract: BACKGROUND
  Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Seventy children were prospectively included if they fulfilled the diagnosis criteria for VAP referenced by the Centers for Disease Control and Prevention. The primary outcome was performance of mCPIS calculated on day 1 to accurately identify VAP as defined by microbiological data.
  
  
  RESULTS
  The data showed that an mCPIS of 6 or higher had a sensitivity of 94%, specificity of 50%, positive predictive value of 64%, negative predictive value of 90%, a positive likelihood ratio of 1.88, and a negative likelihood ratio of 0.11. The area under the receiver operating characteristic curve was 0.70. A positive posttest result increased the disease probability by 15.4%, whereas a negative test result reduced the probability by 38.6%. Patients with an mCPIS of 6 or higher had longer length of mechanical ventilation and pediatric intensive care unit stay compared with patients with an mCPIS lower than 6.
  
  
  CONCLUSIONS
  The mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil. Electronic address: psls.nat@terra.com.br.
authors.forename: Paulo Sérgio Lucas
authors.initials: PS
authors.lastname: da Silva
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil.
authors.forename: Vânia Euzébio
authors.initials: VE
authors.lastname: de Aguiar
authors.affiliation: Pediatric Intensive Care Unit and Department of Neonatology, Universidade de São Paulo, São Paulo, Brazil; Children's Institute, Faculty of Medicine Clinics Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Werther Brunow
authors.initials: WB
authors.lastname: de Carvalho
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Cunio
authors.initials: MC
authors.lastname: Machado Fonseca
mesh_terms: D019540:Area Under Curve; D002675:Child, Preschool; D016638:Critical Illness; D003948:Diagnostic Techniques, Respiratory System; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014481:United States
keywords: Clinical pulmonary infection score; Mechanical ventilation; Pediatric; Ventilator-associated pneumonia