Study examined clinical algorithms relevant for diagnosis and treatment of spinal cord injury (SCI)-associated pneumonia (SCI-AP) in Germany. The clinical decision-making on SCI-AP and the utility of the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of ‘clinically defined pneumonia’ were assessed using a standardized questionnaire including eight case vignettes of suspected SCI-AP. The diagnostic decisions based on the case information were analyzed using classification and regression trees (CART). A standardized questionnaire was sent to 161 German intensive care units, trauma, orthopedic, and neurosurgery departments in May 2013. In total, 61 (38 percent) of the addressed departments responded to the questionnaire. The majority of responding departments were aware of the CDC-criteria (88 percent). In the clinical vignettes, 38–81 percent of the departments diagnosed SCI-AP in accordance with the CDC criteria and 7–41 percent diagnosed SCI-AP in deviation from the CDC criteria. The diagnostic agreement was not associated with the availability of standard operating procedures for SCI-AP management in the departments. CART analysis identified radiological findings, fever, and worsened gas exchange as most important for the decision on SCI-AP. Frequently requested supplementary diagnostics were microbiological analyses, C-reactive protein, and procalcitonin. For empirical antibiotic therapy, the departments used (acyl-)aminopenicillins/β-lactamase inhibitors, cephalosporins, or combinations of (acyl-)aminopenicillins/β-lactamase inhibitors with fluoroquinolones or carbapenems. The survey revealed a diagnostic ambiguity regarding SCI-AP despite the awareness of CDC criteria and established SOPs. Heterogeneous clinical practice is encouraging the development of disease-specific guidelines for diagnosis and management of SCI-AP.
Author(s):
Druschel, Claudia |Ossami Saidy, Ramin R. |Grittner, Ulrike |Nowak, Claus P. |Meisel, Andreas |Schaser, Klaus-Dieter |Niedeggen, Andreas |Liebscher, Thomas |Kopp, Marcel A. |Schwab, Jan M.|
