The futility of the clinical pulmonary infection score in XXXX @entity1 .

@entity1 @entity772 @entity2489 @entity1850 @entity130
INTRODUCTION: The Clinical Pulmonary Infection Score (CPIS) has received much attention recently. Advocates have touted its use for the diagnosis and duration of therapy in @entity1 with @entity2489 ( @entity2489 ). However, little has been written about its utility in @entity130 @entity1 . The clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury. Quantitative cultures of the lower airway have been shown to be efficacious in differentiating @entity2489 from the @entity1850 ( @entity1850 ). In this study, we evaluated the potential use of CPIS as the sole means for diagnosis of @entity2489 in critically injured @entity1 . METHODS: @entity1 were identified from the @entity2489 database maintained in our Level I @entity130 center. Only those who had CPIS calculated at the time of bronchoscopy with BAL were included. @entity2489 required >or=10 colonies/mL on quantitative BAL for diagnosis. Antibiotic therapy was based on quantitative BAL results. @entity1 with <10 colonies/mL were diagnosed with @entity1850 . Sensitivity and specificity of a CPIS>6 for @entity2489 diagnosis (confirmed by BAL) were calculated. RESULTS: In all, 158 @entity1 underwent 285 BALs. The overall incidence for @entity2489 was 42%. @entity1 with episodes of @entity2489 and @entity1850 were well matched for age, Injury Severity Score, APACHE II score, and Glasgow @entity772 Scale score. The average CPIS was 6.8 in @entity1 with @entity1850 and 6.9 for those with @entity2489 . Using a CPIS>6 as the threshold for @entity2489 only yielded a sensitivity of 61% and a specificity of 43%. CONCLUSIONS: CPIS cannot differentiate @entity2489 from @entity1850 in critically injured @entity1 . Using CPIS to initiate antibiotic therapy in @entity130 @entity1 could be harmful. Whether CPIS is useful to determine duration of antibiotic therapy is unknown.
