Kinlin et al developed a clinical prediction rule for nosocomial pneumonia following coronary artery bypass graft surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Hospital for Sick Children, University of Toronto, Ontario Agency for Health Protection and Promotion, Tenet Healthcare and Partners Community Health.
Patient selection: coronary artery bypass graft (CABG) surgery
Outcome: nosocomial pneumonia
Parameters:
(1) body weight (underweight if body mass index < 18.5 kg per square meter)
(2) preadmission residence
(3) smoking history
(4) cancer history
(5) chronic obstructive pulmonary disease (COPD)
(6) prior CABG with internal mammary artery graft
(7) Canadian Cardiovascular Society (CCS) class (from 1 to 4)
(8) serum creatinine concentration in mg/dL
(9) timing of surgery (emergency, urgent, elective)
(10) preoperative infusion of vancomycin
(11) intraoperative blood transfusion
(12) PTCA (percutaneous transluminal coronary angioplasty) during hospital stay
(13) number of days with mechanical ventilation
|
Parameter
|
Finding
|
Points
|
|
body weight
|
normal or overweight
|
0
|
|
|
underweight
|
7
|
|
preadmission residence
|
residential
|
0
|
|
|
nonresidential (long-term care facility, etc)
|
3
|
|
smoking history
|
nonsmoker
|
0
|
|
|
smoker
|
4
|
|
cancer history
|
no
|
0
|
|
|
yes
|
4
|
|
COPD
|
absent
|
0
|
|
|
present
|
3
|
|
prior CABG
|
no
|
0
|
|
|
yes
|
5
|
|
CCS class
|
1 or 2
|
0
|
|
|
3 or 4
|
2
|
|
serum creatinine
|
<= 1.2 mg/dL
|
0
|
|
|
> 1.2 mg/dL
|
3
|
|
timing
|
emergency
|
3
|
|
|
nonemergency
|
0
|
|
preoperative vancomycin
|
no
|
0
|
|
|
yes
|
4
|
|
intraoperative transfusion
|
no
|
0
|
|
|
yes
|
2
|
|
PTCA during stay
|
no
|
0
|
|
|
yes
|
5
|
|
mechanical ventilation
|
<= 1 days
|
0
|
|
|
> 1 day
|
11
|
total score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score: 56
• The higher the score the greater the risk for nosocomial pneumonia.
X =
= (0.1598 * (score)) - 5.7031
probability of nosocomial pneumonia =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.75 to 0.78.
