CABG Surgery Risk of Nosocomial Pneumonia | Clinical Prediction Rule

Description

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.

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Description

Specialty

Objective

ICD-10

CABG Surgery Risk of Nosocomial Pneumonia | Clinical Prediction Rule

Purpose: To evaluate a patient undergoing coronary artery bypass graft (CABG) surgery for risk of nosocomial pneumonia using the score of Kinlin et al.

Description

Specialty

Objective

ICD-10