Kinlin et al developed a clinical rule for predicting nosocomial pneumonia occurring in a patient undergoing coronary artery bypass graft (CABG) surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Hospital for Sick Children in Toronto, University of Toronto, Tenet Healthcare in Dallas and Partners Community Health in Boston.
Parameters:
(1) body weight
(2) residence prior to admission
(3) smoking history
(4) cancer history
(5) chronic obstructive pulmonary diseae (COPD)
(6) history of prior CABG using an internal mammary artery graft (IMAG)
(7) Canadian Cardiovascular Society (CCS) class
(8) serum creatinine
(9) timing of surgery
(10) administration of vancomycin prior to surgery (versus use of cephalosporin)
(11) intraoperative blood transfusion
(12) percutaneous transluminal coronary angioplasty (PTCA) during current hospital stay
(13) ventilation duration in days
|
Parameter |
Finding |
Points |
|---|---|---|
|
body weight |
normal or obese |
0 |
|
|
underweight |
7 |
|
residence prior to admission |
residential |
0 |
|
|
nonresidential |
3 |
|
smoking history |
absent |
0 |
|
|
present |
4 |
|
cancer history |
absent |
0 |
|
|
present |
4 |
|
COPD |
absent |
0 |
|
|
present |
3 |
|
history of CABG using IMAG |
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 of surgery |
routine or urgent |
0 |
|
|
emergent |
3 |
|
vancomycin prior to surgery |
no |
0 |
|
|
yes |
4 |
|
intraoperative blood transfusion |
no |
0 |
|
|
yes |
2 |
|
PTCA during hospital stay |
no |
0 |
|
|
yes |
5 |
|
ventilation duration |
<= 1 day |
0 |
|
|
> 1 day |
11 |
where:
• Nonresidential admission includes an acute care facility, residential or skilled nursing home, rehabilitation facility, etc.
total score =
= SUM(points for all of the parameters)
X =
= (0.1598 * (score)) – 5.7031
probability of nosocomial pneumonia =
= 1 / (1 + EXP((-1) * X))
Interpretation:
• minimum score: 0
• maximum score: 56
• The higher the score the greater the risk for a nosocomial pneumonia occurring.
Performance:
• The area under the ROC curve was 0.75 to 0.78.
Purpose: To evaluate a patient undergoing coronary artery bypass graft (CABG) surgery for risk of nosocomial pneumonia using the score of Kinlin et al.
Specialty: Infectious Diseases, Pulmonology
Objective: risk factors, complications
ICD-10: I20-I25, J12, J13, J14, J15, J16, J17, J18,
