Community acquired pneumonia (CAP) is a common problem in clinical practice. Different recommendations regarding type and degree of diagnostic testing in patients admitted to the intensive care unit (ICU) are found in CAP guidelines from various professional societies. Our aim was to document the diagnostic procedures that clinicians use to assess patients with CAP admitted to the ICU.
Self-administered survey to assess physician preferences about CAP diagnostic approach in patients admitted to the ICU. Survey was generated based on literature review and committee consensus regarding diagnostic tests for CAP patients admitted to the ICU. Subgroup analysis was performed comparing academic practitioners vs. non-academic practitioners, and whether they work in an open ICU vs. closed ICU. The survey was e-mailed to ACCP members (in Chest infections and Critical Care network) in 2004.
A total of 393 questionnaires (19% of submitted) were returned. The most common diagnostic methods used by clinicians were blood cultures (97%), sputum gram stain (83%), sputum culture (85%), Legionella urinary antigen (77%) and endotracheal aspirate (76%). Academic practitioners (n=182) ordered more endotracheal aspirates (79% vs. 68%; p=0.03), Legionella cultures (37% vs. 27%; p=0.05), but less serologic tests for atypical pathogens (34% vs. 46%; p=0.03) than non-academic practitioners (n=203). Practitioners working in a closed ICU (n=159) ordered more blood cultures (99% vs. 93%; p=0.01), and Legionella sputum cultures (39% vs. 26%; p=0.01) than those working in an open ICU (n=224). No other statistical significant differences were observed between groups for other diagnostic methods.
Important differences were found in academic versus non-academic practitioners, and open ICU versus closed ICU situations regarding the diagnostic methods use in clinical practice for patients in the ICU with CAP. Current clinical practice guidelines for CAP diagnosis are applied differently according to type of practitioners and the setting where they work.
Differences in clinician practice preferences in regard to diagnosis of CAP patients in the ICU should be taken into account for future, clinical, educational and research studies.
Marcos Restrepo, None.