Hospitals need a clinically viable tool for differentiating between infectious and noninfectious ventilator-associated events at the patient bedside, according to a study in the American Journal of Infection Control.
Many providers use the clinical pulmonary infection score, or CPIS, to help diagnose VAEs, but the tool is insufficiently sensitive and specific. To help develop a more accurate electronic search algorithm to differentiate between the two types of VAEs, researchers examined 164 patients who experienced 185 VAEs using the CDC's National Health Safety Network data.
They found the variables that most accurately predicted the events were high fever two days before VAE onset, oxygenation changes and appearance of respiratory secretions. Other variables — including laboratory tests, radiologic findings and vital sign values — had no statistical significance.
Using that information, the researchers built a multivariate regression model, with 68 percent sensitivity and 75 percent specificity, which is modestly better than the CPIS model, which demonstrates 50 percent sensitivity and 59 percent specificity.
"Although diagnosis of VAEs remains challenging, our data indicate that clinical signs and symptoms of a VAE may be present up to 2 days before they screen positive. Sputum, fever, and oxygenation requirements all were indicative, but aggregate models failed to create a sensitive and specific model for differentiation of VAEs," wrote the study authors. "The existing clinical tool, the CPIS, is also insufficiently sensitive and specific. Further research is needed to create a clinically viable tool for differentiating VAE types at the bedside."
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