The use of the Clinical Pulmonary Infection Score (CPIS) has falled out of favor with some ICU teams and evidence is mounting that casts doubts on its utility. CPIS score rates a patient in four categories – body temperature, white blood cell count, purulent sputum, and new or changing infiltrate on chest radiograph. A score of 6 or higher is considered to be indicative of a pulmonary infection.
In data presented at the 2011 American Association for the Surgery of Trauma meeting, Dr. Nancy Parks of the Elvis Presley Memorial Trauma Center in Memphis, Tennessee cited data from 2006 showing the difficulty of using CPIS to distinguish between pulmonary infection and posttraumatic systemic inflammatory response syndrome in the initiation of antibiotic coverage.
Dr. Parks team is also suggesting that the CPIS score can not be used to determine when to stop the use of antibiotics in ventilator associated pneumonia in trauma patients. In patients with a clinical suspicion of pulmonary infection bases on CPIS, a bronchoalveolar lavage (BAL) was performed. If the effluent had 10 X 5 colony forming units, the patient was started on antibiotics. On day 4, the BAL was repeated and the infection was deemed treated if the number of colony forming units was 10 x 3 or less.
Dr. Parks team found that BAL evidence showed resolution of infection in multiple cases where CPIS score was still above 6. Her group calculated a senstivity and specificity of 69% and 51% respectively in the community-acquired group and 72% and 53% in the hospital-acquired infections. Overall, she concluded that if CPIS had been used to guide therapy, 59% of the patients would have had antibiotics continued inappropriately.
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