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Table 2 Performance characteristics of ventilator-associated pneumonia diagnostic algorithms

From: A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study

Criteria Studied

Year, (citation)

Population

Comparator

Sample Size

Sensitivity

Specificity

PPV

NPV

( +) LR

(-) LR

ROC AUC

Kappa (ĸ) index, agreement level a

CDC/NHSN

2015, (60)

Mixedb

CPIS

38

0.37

1.0

1.0

0.84

   

ĸ = 0.47, moderate

CPIS

1999, (43)

Mixedb

Pathology

23

0.77

0.42

      

CPISc

2004, (66)

Mixedb

Quantitative Cultures

69

0.41

0.77

0.8

0.36

  

0.64

 

CPIS

2004, (67)

Mixedb

Quantitative Cultures

88

0.89

0.47

0.57

0.84

   

ĸ = 0.33, fair

CPIS

2007, (68)

Burn

Quantitative Cultures

28

0.30

0.80

0.70

0.50

    

CPIS

2010, (40)

Mixedb

Pathology

142

0.46

0.60

  

1.13

0.96

  

CPIS

2015, (69)

Surgical (mixed)

Quantitative Cultures

497

0.633

0.644

0.61

0.674

  

0.60

 

CPIS

2018, (70)

Surgical (acute care)

Quantitative Cultures

198

0.611

0.781

0.64

0.759

    

HELICS

2013, (36)

Mixedb

Not clearly specified

57d

0.86

0.99

0.77

0.995

   

ĸ = 0.80, substantial

Johansene

1999, (43)

Mixedb

Pathology

23

0.69

0.75

      

Johansen

2018, (70)

Surgical (acute care)

Quantitative Cultures

198

0.828

0.59

0.564

0.843

    

NTDB/NTR

2015, (71)

Trauma

CDC/NHSN

279

0.864

0.578

0.74

0.74

   

ĸ = 0.47, moderate

  1. CDC/NHSN: centers for disease control and prevention national health safety network; ICU: intensive care unit; MV: mechanical ventilation; NR: not reported; NTDB/NTR: national trauma data bank / national trauma registry; NPV: negative predictive value; PPV: positive predictive value; ROC AUC: receiver operating curve area under curve; ( +) LR: positive likelihood ratio; (-) LR: negative likelihood ratio
  2. aAgreement based on score: ≤ 0 (no agreement); 0.01–0.20 (slight); 0.21–0.40 (fair); 0.41– 0.60 (moderate); 0.61–0.80 (substantial); and 0.81–1.00 (almost perfect agreement)
  3. bA mixed population containing both medical and surgical patients. Studies that did not specify ICU type were by default classified as mixed
  4. cFor CPIS threshold of > 7, rather than current standard of > 6. The AUC using threshold CPIS > 6 was 0.54, other values not reported
  5. dData from sub-population of a larger study assessing various types of ICU-acquired infections
  6. eThe presence of all three criteria increased the specificity to 92% at the cost of a high beta error (sensitivity 23%)