当前位置： SCI文献检索 > ANAESTHESIA AND INTENSIVE CARE期刊下所有文献 > Predictors of physician confidence to diagnose pneumonia and determine illness severity in ventilated patients. Australian and New Zealand practice in intensive care (ANZPIC II).

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 ventilator-associated (VAP), clinician determined illness severity (CDIS), diagnostic methods, clinical diagnostic confidence (CDC), microbiological isolates and antibiotic use. For 476 episodes of pneumonia (48% CAP, 24% HAP, 28% VAP), CDC was greatest for CAP (64% CAP, 50% HAP and 49% VAP, P<0.01) or when pneumonia was considered "life-threatening" (84% high CDC, 13% medium CDC and 3% low CDC, P<0. 001). "Life-threatening" pneumonia was predicted by worsening gas exchange (OR 4.8, CI 95% 2.3-10.2, P<0.001), clinical signs of consolidation (OR 2.0, CI 95% 1.2-3.2, P<0.01) and the Sepsis-Related Organ Failure Assessment (SOFA) Score (OR 1.1, CI 95% 1.1-1.2, P<0.001). Diagnostic confidence increased with CDIS (OR 16.3, CI 95% 8.4-31.4, P<0.001), definite pathogen isolation (OR 3.3, CI 95% 2.0-5.6) and clinical signs of consolidation (OR 2.1, CI 95% 1.3-3.3, P=0.001). Although the CDIS, SOFA Score and the Simplified Acute Physiologic Score (SAPS II) were all associated with mortality, the SAPS II Score was the best predictor of mortality (P = 0. 02). Diagnostic confidence for pneumonia is moderate but increases with more classical presentations. A small set of clinical parameters influence subjective assessment. Objective assessment using SAPS II Scoring is a better predictor of mortality.

journal_name

Anaesth Intensive Care

journal_title

Anaesthesia and intensive care

authors

Boots RJ,Lipman J,Bellomo R,Stephens D,Heller RE

doi

10.1177/0310057X0503300117

keywords:

subject

Has Abstract

pub_date

2005-02-01 00:00:00

pages

112-9

issue

eissn

0310-057X

issn

1448-0271

pii

2004069

journal_volume

pub_type

杂志文章,多中心研究

在线工具

Predictors of physician confidence to diagnose pneumonia and determine illness severity in ventilated patients. Australian and New Zealand practice in intensive care (ANZPIC II).