Comparison Of Clinical Pulmonary Infection Score (CPIS) versus Johanson Criteria for The Diagnosis Of Ventilator Associated Pneumonia (VAP)

Abstract

INTRODUCTION: A prospective observational cohort study was carried out in ICU patients requiring ventilatory support for 48 hrs or more to compare the diagnostic tool of clinical pulmonary infection score (CPIS) versus Johanson criteria for the diagnosis of ventilator associated pneumonia (VAP).
MATERIAL AND METHODS: After obtaining approval from the ethics committee and informed written consent from the patient’s relatives an observational study was carried out in 25 patients admitted to the ICU, in Government Medical College and Hospital Chandigarh, in a 2-month period. The inclusion criteria were adults (18-80yrs) who required ventilator support for a minimum of 48 hrs. Patients with primary respiratory pathology and those not requiring ventilator or requiring ventilator for <48hrs were excluded from the study. The study group was regularly evaluated for development of VAP based on CPIS which was compared to Johanson clinical criteria. Data was expressed as median ±interquartile range (QR), minimum-maximum. Fischer and Pearson Chi-square tests, Mann-Whitney U test were used for statistical analysis. P<0.05 was considered as significant. The sensitivity, specificity and positive and negative predictive values (PPV, NPV) of CPIS were determined by comparing patients of VAP with non-VAP. CPIS evaluation includes- body temperature, leucocyte count, tracheal secretions, oxygenation, chest x-ray findings, tracheal culture aspirate. The Johanson clinical criteria includes- new infiltrates on chest x-ray and at least 2 of the following: leukocytosis, leucopenia, fever, hypothermia and purulent tracheal secretions.
RESULTS: Taking Johanson criteria as the reference standard, CPIS had a sensitivity of 60% and specificity of 90% on 3rd day which increased considerably by 5th day to 100% to 87.6% respectively. The PPV was 60% and 83.3% on the 3rd and 5th day respectively. The corresponding NPV were 90% and 100% respectively.
CONCLUSION: CPIS can be used as an effective and comprehensive screening tool for the diagnosis of VAP which will help reduce overtreatment significantly.