title: Evaluation of the Infection-Related Ventilator-Associated Events Algorithm for Ventilator-Associated Pneumonia Surveillance in a Trauma Population.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention have recently introduced new ventilator-associated pneumonia (VAP) surveillance on the basis of the infection-related ventilator-associated complication (IVAC) definition. We aim to evaluate the accuracy of this new IVAC algorithm for detecting VAP according to the 2008 Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) definition as the reference diagnosis (VAP-NHSN) in high-risk trauma patients.
  
  
  METHODS
  This retrospective single-center study included all trauma subjects who were admitted to the ICU, required mechanical ventilation for >48 h, and received a blood transfusion. The new IVAC surveillance and the criteria for VAP-NHSN diagnosis were applied. The accuracy of the new IVAC surveillance for detecting VAP-NHSN was determined, and the clinical outcomes were compared between groups.
  
  
  RESULTS
  The sensitivity, specificity, and positive and negative predictive values of IVAC for VAP-NSHN identification were 28.12%, 91.45, 58.06%, and 75.14%, respectively. Subjects with IVAC, VAP-NHSN, or both had higher morbidity when compared with those without IVAC and VAP-NHSN. Subjects with IVAC only had lower morbidity compared with those with VAP-NHSN only or those with both IVAC and VAP-NHSN. There was no significant difference in clinical outcomes between subjects with VAP-NHSN only and those with both IVAC and VAP-NHSN.
  
  
  CONCLUSIONS
  IVAC criteria had a low accuracy for identifying VAP-NHSN in subjects with high-risk trauma.
authors.affiliation: Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Annop
authors.initials: A
authors.lastname: Piriyapatsom
authors.affiliation: Department of Pharmacy.
authors.forename: Hsin
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Pirrone
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Pascale
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Javier
authors.initials: J
authors.lastname: Corona De Lapuerta
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.affiliation: Department of Anesthesiology, University of California, San Diego, California.
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Schmidt
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Marc
authors.initials: M
authors.lastname: De Moya
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine lberra@mgh.harvard.edu.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D012122:Ventilators, Mechanical / Q000009:adverse effects; D014947:Wounds and Injuries / Q000150:complications*
keywords: accuracy; critical care; trauma; ventilator-associated events; ventilator-associated pneumonia