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- Title
A Bayesian decision-support system for diagnosing ventilator-associated pneumonia.
- Authors
Schurink, Carolina; Visscher, Stefan; Lucas, Peter; Leeuwen, Henk; Buskens, Erik; Hoff, Reinier; Hoepelman, Andy; Bonten, Marc; Schurink, Carolina A M; Lucas, Peter J F; van Leeuwen, Henk J; Hoff, Reinier G; Hoepelman, Andy I M; Bonten, Marc J M
- Abstract
<bold>Objective: </bold>To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP).<bold>Design: </bold>A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a prospectively studied cohort of 872 ICU patients, VAP was diagnosed by two infectious-disease specialists using a decision tree (reference diagnosis). After internal validation daily BDSS predictions were compared with the reference diagnosis. For data analysis two approaches were pursued: using BDSS predictions (a) for all 9422 patient days, and (b) only for the 238 days with presumed respiratory tract infections (RTI) according to the responsible physicians.<bold>Measurements and Results: </bold>157 (66%) of 238 days with presumed RTI fulfilled criteria for VAP. In approach (a), median daily BDSS likelihood predictions for days with and without VAP were 77% [Interquartile range (IQR) = 56-91%] and 14% [IQR 5-42%, p < 0.001, Mann-Whitney U-test (MWU)], respectively. In receiver operating characteristics (ROC) analysis, optimal BDSS cut-off point for VAP was 46%, and with this cut-off point positive predictive value (PPV) and negative predictive value (NPV) were 6.1 and 99.6%, respectively [AUC = 0.857 (95% CI 0.827-0.888)]. In approach (b), optimal cut-off for VAP was 78%, and with this cut-off point PPV and NPV were 86 and 66%, respectively [AUC = 0.846 (95% CI 0.794-0.899)].<bold>Conclusions: </bold>As compared with the reference diagnosis, the BDSS had good test characteristics for diagnosing VAP, and might become a useful tool for assisting ICU physicians, both for routinely daily assessment and in patients clinically suspected of having VAP. Empirical validation of its performance is now warranted.
- Subjects
PNEUMONIA; ARTIFICIAL respiration complications; NOSOCOMIAL infections; BAYESIAN analysis; DECISION trees; INTENSIVE care units; CRITICAL care medicine
- Publication
Intensive Care Medicine, 2007, Vol 33, Issue 8, p1379
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-007-0728-6