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Table 2 Studies comparing clinical criteria to other diagnostic (Dx) tests

From: Diagnosis of ventilator-associated pneumonia: a systematic review of the literature

First author Sample Dx Tests Gold standard Results
Fabregas, 1999, ** [11] Medical ICU, 25 pts Johanson criteria, CPIS, TBA(105), PSB (103), pBAL(104), BAL(104) Pathology + Culture • Johanson criteria (2 items): sens = 69%, spec = 75%.
• Any Johanson criteria: Chest Rx: sens = 92%, spec = 33%; leukocytosis: sens = 77%, spec = 58%; fever: sens = 46%, spec = 42%; purulent secretions: sens = 69%, spec = 42%
• CPIS: sens = 77%, spec = 42%.
• TBA sens = 69%, spec = 92%.
• pBAL sens = 39%, spec = 100%.
• BAL sens = 77%, spec = 58%.
• PSB sens = 62%, spec = 75%.
• QtC added little to clinical diagnostic accuracy
Papazian, 1995, ** [17] Mixed ICU, 38 pts, consecutive BBS (104) & mini-BAL (103) & PSB (103) & BAL (104) & CPIS Pathology + Culture • CPIS: sens = 72%; spec = 85%
• BBS (104): sens = 83%, spec = 80%
• mini-BAL (103): sens = 67%, spec = 80%
• BAL: sens (104) = 58%, spec = 95%
• PSB: sens (103) = 42%, spec = 95%
• BBS was more accurate than PSB
Croce, 2006 *, # [18] Trauma ICU, 158 pts CPIS (>6) BAL (105) • Frequency of VAP: BAL ≥ 105 = 42%, SIRS = 58%
• Average CPIS: VAP = 6.9, SIRS = 6.8
• CPIS > 6: sens = 61%, spec = 43%
Luyt, 2004 *, ** [19] Mixed ICU, 201 pts CPIS (>6) PSB (103) BAL (104) • CPIS: sens = 89%, spec = 44%, k = 0.33, PPV = 57%, NPV = 84%
Schurink, 2004, ** [20] Mixed ICU, 99 pts CPIS BAL (104) • Frequency of VAP = 69%
• ROC curve for CIPS > 6, 7 and 8 = 0.54, 0.64, 0.64; r = 0.115
• CPIS > 5: sens = 83%, spec = 17%
• CIPS >6 or ≤ 6: k 0.16
Fartoukh, 2003, ** [21] Mixed ICU, 68 pts CE & PIS (>6) BAL (104) or PTC (103) • CE: sens = 50%, spec = 59%
• CPIS > 6: sens = 60%, spec = 59%
• Adding positive Gram stain to CIPS improves diagnostic accuracy
Miller, 2006, ** [15] Trauma ICU, 292 pts NNIS BAL (105) • k = 0.73.
• Sens = 84%, spec = 69%, PPV = 83%, NPV = 70%
Pham, 2007*, ** [23] Mixed ICU, 28 burn pts CPIS BAL • CPIS: sens = 30%, spec = 80%, PPV = 70%, NPV = 50%
Pugin, 1991, **, [16] Surgical ICU, 28 pts, CPIS & mini-BAL (BI ≥ 5) BAL (BI ≥ 5) • CPIS: sens = 93%, spec = 100%, r = 84% (CIPS and mini-BAL), r = 76% (CPIS and BAL)
• Mini-BAL: sens = 73%, spec = 96%
  1. CPIS = clinical pulmonary infection score; TBA = tracheobronchial aspirate; PSB = protected specimen brush; pBAL = protected BAL or 'mini-BAL'; BAL = bronchoalveolar lavage; sens = sensitivity; spec = specificity; QtC = quantitative culture; BBS = blind bronchial sampling; SIRS = systemic inflammatory response syndrome; PPV = positive predictive value; NPV = negative predictive value; CE = clinical estimate; NNIS = National nosocomial infection surveillance system; BI = bacterial index; ICU = intensive care unit; *retrospective; **consecutive; #convenient.