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Updated: Jun 25, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
The Clinical Pulmonary Infection Score Combined with Procalcitonin and Lung Ultrasound (CPIS-PLUS), a Good Tool for
Judit Becerra-Hervás1,2, Carmina Guitart1,3, Aina Covas4
1Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain.
Insights
A new score, CPIS-PLUS, combining lung ultrasound and procalcitonin shows promise for early ventilator-associated pneumonia (VAP) diagnosis in pediatric intensive care units, improving accuracy over existing methods.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Infectious disease diagnostics
Background:
- Ventilator-associated pneumonia (VAP) poses a significant challenge in Pediatric Intensive Care Units (PICUs).
- Current diagnostic methods for VAP lack definitive accuracy, hindering timely intervention.
- Early detection of VAP is critical for improving patient outcomes.
Purpose of the Study:
- To identify key lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric VAP.
- To develop and evaluate a novel early diagnosis score, CPIS-PLUS, for VAP in pediatric patients.
- To compare the diagnostic performance of CPIS-PLUS against the traditional Clinical Pulmonary Infection Score (CPIS).
Main Methods:
- A prospective longitudinal and interventional study design was employed.
- Pediatric patients with suspected VAP were enrolled and classified using CDC criteria.
- Chest X-ray (CXR), LUS, procalcitonin levels, and CPIS were assessed within 12 hours of admission.
Main Results:
- Out of 108 suspected VAP patients, 51 (47%) were diagnosed with VAP.
- CPIS-PLUS demonstrated high diagnostic accuracy for VAP, with 80% sensitivity and 73% specificity.
- The area under the curve (AUC) for CPIS-PLUS was 0.86, significantly higher than CPIS (0.61).
Conclusions:
- The CPIS-PLUS score shows potential as a reliable tool for the early diagnosis of VAP in pediatric patients.
- This novel score integrates LUS findings and PCT values to enhance diagnostic capabilities.
- Further internal and external validation studies are recommended to confirm the clinical utility of CPIS-PLUS.
Abstract:
Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.
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