Loading...
Please wait, while we are loading the content...
Similar Documents
Clinical criteria in the diagnosis of ventilator-associated pneumonia.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wunderink, Richard G. |
| Copyright Year | 2000 |
| Abstract | T his section discusses the accuracy of the traditional clinical criteria of fever, leukocytosis, and purulent tracheal secretions, usually with abnormal radiographic signs, as initial possible indicators of ventilator-associated pneumonia (VAP). A major methodological problem in assessing the sensitivity or specificity of these clinical criteria is obtaining the correct denominator. Instead of providing the total number of patients at risk, many studies give only the number who met at least one criterion or the number who gave a subjective clinical impression of being at risk for VAP. Therefore, sensitivities may be lower and specificities higher if data from these studies are applied to the entire population of ventilator-assisted patients. Conversely, the sensitivity derived from the entire population is inappropriately high when applied only to a preselected population, such as all febrile patients or all patients with purulent tracheal secretions. The appropriate calculation depends on the question being addressed. If the clinical criteria are used to select a population at high risk of VAP, population-based statistics should be used. If, however, the goal is to discriminate between patients with VAP and those with a mimicking condition, the criteria characteristics in the suspected VAP group should be used. Both issues are clinically relevant, and operating characteristics in each population are calculated when possible. Use of the sensitivity and specificity calculated from these studies requires careful attention to the population being discussed. Most studies assume that all patients who had no clinical findings did not have pneumonia. No study mentions that unsuspected pneumonia was documented in patients who did not meet study entry criteria. The fact that autopsy studies regularly show pneumonia in patients not treated with antibiotics suggests that a subjective clinical impression that pneumonia is not present may be inaccurate in some patients. Systematic overestimation of sensitivity may result. In one autopsy study, 9% of patients who were not given antibiotic therapy, and died, had VAP.84 Data on the original clinical suspicion were available for eight studies (Tables 7–8).11,12,20,21,38–41 Performance Characteristics |
| Starting Page | 191S |
| Ending Page | 194S |
| Page Count | 4 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21944/191s.pdf |
| PubMed reference number | 10816035v1 |
| Volume Number | 117 |
| Issue Number | 4 |
| Journal | Chest |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Antibiotic therapy Antibiotics Bodily secretions Carbohydrate Processing Inhibitor Cessation of life Denominator Diagnosis, clinical Diagnostic Techniques, Otological Fever Leukocytosis Patients Pneumonia Pneumonia, Ventilator-Associated Reflex, Abnormal Respiratory Tract Diseases Respiratory Tract Neoplasms Respiratory tract structure Signs and Symptoms Tracheal Diseases Ventilator - respiratory equipment |
| Content Type | Text |
| Resource Type | Article |
