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clinical investigations in critical careReproducibility of the Histologic Diagnosis of Pneumonia Among a Panel of Four Pathologists: Analysis of a Gold Standard
Section snippets
Study Design
Prospective, cross-sectional study of 40 patients dying while receiving mechanical ventilation.
Patient Population
Patients were recruited from the combined medical-surgical ICU of a 234-bed teaching hospital. The criteria for inclusion were as follows: (1) the patient died following at least 24 h of mechanical ventilation; (2) the patient was hospitalized for a minimum of 72 h prior to death; and (3) specimen collection could be initiated within 2 h of death. The criteria for exclusion were as follows: (1)
Results
From August 1991 to October 1994, 40 patients were prospectively enrolled. The pathology specimen from one patient was lost in the course of the study and the related data were excluded from analysis. Collection of specimens was initiated a mean 57 min after death (range, 15 to 120 min). The group consisted of 20 women and 19 men with a mean age of 66 years (range, 38 to 85 years). Thirty-six of 39 patients had airspace disease on their most recent chest radiograph and 38 of 39 patients had
Discussion
Validation of histologic pneumonia is the essence of studies correlating microbiological data with postmortem pathologic findings in patients with VAP. Despite this, to our knowledge, no prior study has tested the reproducibility of histologic diagnosis or tried to establish diagnostic references. The tacit presumption has been “the pathologist can recognize pneumonia.” A 1992 consensus conference addressing standardization in study design defined VAP as “a nosocomial, usually bacterial
ACKNOWLEDGMENT
The authors gratefully acknowledge Rae Wu, MA, MPH, for her statistical analysis, and Jane Lopez for her superb assistance in manuscript preparation and editing.
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This work was funded by the Edward H. Morgan Fund for Clinical Research in Pulmonary Disease, Virginia Mason Research Center, Seattle.