SCORING SYSTEM FOR NOSOCOMIAL PNEUMONIA IN ICUS

Objective: To develop a scoring system for stratifying patients in int ensive care units (ICUs) by risk of developing nosocomial pneumonia (N P), based on variables generally available in an ICU, and to determine the probability of a patient developing NP in the ICU. Design and set ting: A 2-year prospective cohort study conducted in a medical and sur gical ICU. Patients: 756 patients admitted to the ICU for 48 h or more were followed up until the development of NP or death or discharge fr om the ICU. Measurements and results: 129 (17.1%) patients developed N P, 106 (14%) in the first 2 weeks. The following independent risk fact ors were identified by multivariate analysis: no infection on admissio n [relative risk (RR) = 3.1, 95% confidence intervals (CI)= 2.0 to 4.8 ]; thorax drainage (RR = 2.1, 95% CI = 1.2 to 3.5); administration of antacids (RR = 2.1, 95% CI = 1.4 to 3.1); partial pressure of oxygen ( PO2) > 110 mmHg (RR = 1.6, 95% CI = 1.0 to 2.6); administration of coa gulation factors (RR = 1.8, 95% CI = 1.0 to 3.2); male gender (RR = 2. 7, 95% CI = 1.2 to 6.3); urgent surgery (RR = 2.4, 95% CI = 0.9 to 6.4 ); and neurological diseases (RR = 4.2, 95% CI = 1.9 to 9.4). To obtai n a predictive risk index for NP, a scoring system was developed using a multivariate model. The probability of developing NP varied between 11.0% in the lowest risk group and 42.3% in the highest risk group. T he patients' risk of acquiring NP was seven times higher in the highes t score category (IV) than in the lowest one (I). Conclusions: ICU pat ients can be stratified into high- and low-risk groups for NP. No infe ction on admission, thorax drainage, administration of antacids, and P O2 > 110 mmHg were associated with a higher risk of NP during the enti re 2-week period.