Predictors of Physician Confidence to Diagnose Pneumonia and Determine Illness Severity in Ventilated Patients. Australian and New Zealand Practice in Intensive Care (ANZPIC II)

Abstract

The manner in which elements of clinical history, physical examination and investigations influence subjectively assessed illness severity and outcome prediction is poorly understood. This study investigates the relationship between clinician and objectively assessed illness severity and the factors influencing clinician's diagnostic confidence and illness severity rating for ventilated patients with suspected pneumonia in the intensive care unit (ICU). A prospective study of fourteen ICUs included all ventilated admissions with a clinical diagnosis of pneumonia. Data collection included pneumonia type-community-acquired (CAP), hospital-acquired (HAP) and ventilatorassociated (VAP), clinician determined illness severity (CDIS), diagnostic methods, clinical diagnostic confidence (CDC), microbiological isolates and antibiotic use.

Risk prediction models for mortality in patients with ventilator-associated pneumonia: A systematic review and meta-analysis

“…The selection process is displayed in Figure 1. Eleven of the included articles were prospective [3,4,9,[17][18][19][20][21][22][23][24] and 8 were retrospective [25][26][27][28][29][30][31][32]. The 19 included articles studied 7 models' performance in predicting mortality in VAP patients: 'The Acute Physiology and Chronic…”

“…Health Evaluation II´ (APACHE II) [9,20,21,[24][25][26][27][28]31]; 'Clinical Pulmonary Infection Score' (CPIS) [20][21][22]28]; 'Immunodeficiency, Blood pressure, Multilobular infiltrates on chest radiograph, Platelets and hospitalization 10 days before onset of VAP' (IBMP-10) [24][25][26];'VAP Predisposition, Insult Response and Organ dysfunction´ (VAP PIRO) [9,27]; Sequential Organ Failure Assessment (SOFA) [3,17,18,21,[29][30][31]; Simplified Acute Physiology Score (SAPS II) [3,4,18,19,29,32] and 'The Acute Physiology and Chronic Health Evaluation III´ (APACHE III) score [23]. A summary of the models' variables can be seen in Table 1.…”

“…The diagnosis was supported with microbiology in three papers, although not required for a positive diagnosis [3,20,31].…”

“…Ventilator-associated pneumonia (VAP) affect 10 to 20% of all critically ill patients treated with mechanical ventilation, and carry a mortality of 25 to 50% [1][2][3][4][5][6]. As much as 9 to 13% of all the deaths in mechanically ventilated patients have been attributed to VAP [7,8].…”

Comparison of Acute Physiology and Chronic Health Evaluation (APACHE) II score with organ failure scores to predict hospital mortality

“…However, the ability of the SOFA score to discriminate survivors from non‐survivors has been found to be inconsistent across studies [10, 11]. Although the SOFA scoring system has been used in some Australian ICUs [12], its performance in Australasian ICUs, especially in comparison with the APACHE II score, has not been evaluated. We have reported previously an alternative organ failure score, termed the Royal Perth Hospital Intensive Care Unit (RPHICU) organ failure score (Table 1) [13].…”