Nosocomial Pneumonia ICU Prediction Score | Medical Algorithm

Description

Nosocomial pneumonia is an important problem for patients in the intensive care unit (ICU). 7 parameters were identified by multivariate analysis as being associated with nosocomial pneumonia in ICU patients. These parameters can be used to generate 2 simple scores which can be used to stratify patients by risk shortly after admission, thereby allowing better management.

Patients studied:

(1) Patients were >= 18 years of age.

(2) Study performed at University of Freiburg, Germany from July, 1991 to July 1993.

Parameter Associated with Nosocomial Pneumonia	Relative Risk	95% Confidence Intervals
no infection on admission	3.1	2.0 - 4.8
thorax drainage	2.1	1.2 - 3.5
administration of antacids	2.1	1.4 - 3.1
PaO2 > 110 mm Hg	1.6	1.0 - 2.6
administration of coagulation factors	1.8	1.0 - 3.2
male gender	2.7	1.2 - 6.3
urgent surgery	2.4	0.9 - 6.4

where:

• administration of coagulation factors indicates either use of fresh frozen plasma (FFP) or antithrombin III concentrates

Score for Predicting Pneumonia During Week 1

Parameter	Finding	Points
infection on admission	present	0
	absent	11
thorax drainage	present	7
	absent	0
antacids	given	7
	not given	0
PaO2	> 110 mm Hg	5
	<= 110 mm Hg	0
administration of coagulation factors	given	6
	not given	6

score 1 =

= SUM(points for findings present)

Score for Predicting Pneumonia During Week 2

Parameter	Finding	Points
infection on admission	present	0
	absent	11
thorax drainage	present	7
	absent	0
antacids	given	7
	not given	0
PaO2	> 110 mm Hg	5
	<= 110 mm Hg	0
gender	male	10
	female	0
type of surgery	urgent	9
	elective	0
neurological disease	present	14
	absent	0

score 2 =

= SUM(points for findings present)

Interpretation:

• minimum score 1 and score 2: 0

• maximum score 1: 36

• maximum score 2: 63

Score 1	Group	Percent with Pneumonia for days 1-6
0 - 10	I	5.9%
11 - 15	II	9.3%
16 - 21	III	10.8%
>= 22	IV	26.5%

Table 5, page 1159

Score 2	Group	Percent with Pneumonia for days 7-14
0 - 17	I	6%
18 - 24	II	8.4%
25 - 30	III	26.1%
>= 31	IV	11.6%

Table 5, page 1159

Cumulative Risk

Note: The paper is a little vague in how the data in Table 6 (page 1159) is calculated. I have elected to use the score of all parameters for this, but it may be that only Score 1 is used, since the breakpoints are the same. Alternatively it could be based on findings for no infections, thoracic drainage, use of antacids and PaO2.

Score	Group	Percent with Pneumonia by Day 14
0 - 10	I	11%
11 - 15	II	17.5%
16 - 21	III	18.4%
>= 22	IV	42.3%

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Description

Specialty

Objective

ICD-10

Nosocomial Pneumonia in ICU Prediction Score

Purpose: To use 2 clinical scores to identify an ICU patient at risk for nosocomial pneumonia.

Description

Specialty

Objective

ICD-10