The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters.
Summary of "The Occurrence of Pneumonia Diagnosis Among Neurosurgical Patients: The Definition Matters."
BACKGROUND:
Diagnosis of pneumonia in the hospital setting is a challenge due to the absence of a generally accepted pneumonia definition.
METHODS:
We prospectively evaluated six different clinical criteria for diagnosing pneumonia-physician's diagnosis (A), was compared to common methods, i.e., general surveillance method (B), consensus clinical criteria (C), and other three criteria (D, E, and F) among 390 neurosurgical patients treated in either the intensive care unit or the neurosurgical ward in a university hospital.
RESULTS:
The frequencies of pneumonia cases were: group A, 66 (16.9%); group B, 41 (10.1%); and group C, 55 (14.1%). Only 28 pneumonia cases were identified by all three criteria. The kappa values were: between A and B, 0.42 (95% confidence interval, CI; 0.27-0.57); between A and C, 0.49 (95% CI; 0.35-0.63); and between B and C, 0.68 (95% CI; 0.55-0.80). In group A, there were 34 false positive cases according to criterion B and 25 according to criterion C. Pneumonia cases were identified according to criterion D in 13 (3.3%), E in 35 (9.0%), and F in 51 (13.1%) cases, respectively.
CONCLUSIONS:
There was great variability in the presence of pneumonia among neurosurgical patients, depending on the criteria used. Our results support the idea that a more exact method for pneumonia diagnosis should be implemented to obtain more reliable results in this important infection of hospitalized patients, which is also used for benchmarking purposes. Furthermore, it seems important to treat all clinically suspected pneumonia cases whether or not the surveillance criteria are fulfilled.
Affiliation
Department of Anesthesiology and Division of Intensive Care, Oulu University Hospital, P.O. Box 21, 90029, OYS, Oulu, Finland, petri.kuusinen@oulu.fi.
Journal Details
This article was published in the following journal.
Name: Neurocritical care
ISSN: 1556-0961
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21674278
- DOI: http://dx.doi.org/10.1007/s12028-011-9570-3
Medical and Biotech [MESH] Definitions
Pneumocystis Infections
Infections with species in the genus PNEUMOCYSTIS, a fungus causing interstitial plasma cell pneumonia (PNEUMONIA, PNEUMOCYSTIS) and other infections in humans and other MAMMALS. Immunocompromised patients, especially those with AIDS, are particularly susceptible to these infections. Extrapulmonary sites are rare but seen occasionally.
Pneumonia, Pneumocystis
A pulmonary disease in humans occurring in immunodeficient or malnourished patients or infants, characterized by DYSPNEA, tachypnea, and HYPOXEMIA. Pneumocystis pneumonia is a frequently seen opportunistic infection in AIDS. It is caused by the fungus PNEUMOCYSTIS JIROVECII. The disease is also found in other MAMMALS where it is caused by related species of Pneumocystis.
Neuroendoscopy
PROCEDURES that use NEUROENDOSCOPES for disease diagnosis and treatment. Neuroendoscopy, generally an integration of the neuroendoscope with a computer-assisted NEURONAVIGATION system, provides guidance in NEUROSURGICAL PROCEDURES.
Early Diagnosis
Methods to determine in patients the nature of a disease or disorder at its early stage of progression. Generally, early diagnosis improves PROGNOSIS and TREATMENT OUTCOME.
Pneumonia, Rickettsial
Pneumonia caused by infection with bacteria of the family RICKETTSIACEAE.
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