Analysis of charges associated with diagnosis of nosocomial pneumonia

Can routine bronchoscopy be justified?

Martin Croce, Timothy C. Fabian, Barbara Shaw, Ronald M. Stewart, F. Elizabeth Pritchard, Gayle Minard, Kenneth A. Kudsk, Vickie S. Baselski

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Many ventilated trauma patients thought to have nosocomial pneumonia have pulmonary contusion or systemic inflammatory response syndrome with tracheobronchial colonization. Fiberoptic bronchoscopy with quantitative culture techniques of protected specimen brush (PSB; threshold 103 cfu/mL) or bronchoalveolar lavage (BAL; threshold 10s cfu/mL) can potentially eliminate the false positive cultures of the upper airway seen with routine sputum aspirates (RS). However, bronchoscopy is expensive, and routine use may not be cost effective. This prospective study evaluated the patient charges associated with bronchoscopy and quantitative cultures compared with RS for the diagnosis of nosocomial pneumonia. Specimens were obtained by RS, PSB, and BAL from the lower airway in 107 trauma patients (136 sets of triplicate cultures). All patients had clinical evidence suggestive of pneumonia (fever, leukocytosis, purulent sputum, abnormal roentgenographic findings). Typical oral flora were considered contaminants; no gram-negative specimens were excluded. Mean age was 40 years and mean ISS was 29. Seventy-eight percent had blunt injuries, 22% penetrating, and 42% had chest injuries. The incidence of nosocomial pneumonia according to each method was: RS—73%; PSB—34%; BAL—25%. Considering all charges involved (bronchoscopy, equipment, microbiologic analysis, and antibiotics), and based on a 14-day course of ceftazidime and vancomycin, the charges for PSB were 58% of RS, and charges for BAL were 43% of RS. We conclude that the charges associated with bronchoscopy are high, but can be offset by antibiotic savings. Side effects of unnecessary antibiotic therapy would be avoided. Further study is needed to determine the efficacy of PSB or BAL in trauma patients.

Original languageEnglish (US)
Pages (from-to)721-727
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume37
Issue number5
DOIs
StatePublished - Jan 1 1994

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Bronchoscopy
Sputum
Dimercaprol
Pneumonia
Anti-Bacterial Agents
Wounds and Injuries
Systemic Inflammatory Response Syndrome
Culture Techniques
Thoracic Injuries
Nonpenetrating Wounds
Ceftazidime
Contusions
Leukocytosis
Bronchoalveolar Lavage
Vancomycin
Fever
Prospective Studies
Costs and Cost Analysis
Equipment and Supplies
Lung

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Analysis of charges associated with diagnosis of nosocomial pneumonia : Can routine bronchoscopy be justified? / Croce, Martin; Fabian, Timothy C.; Shaw, Barbara; Stewart, Ronald M.; Pritchard, F. Elizabeth; Minard, Gayle; Kudsk, Kenneth A.; Baselski, Vickie S.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 37, No. 5, 01.01.1994, p. 721-727.

Research output: Contribution to journalArticle

Croce, Martin ; Fabian, Timothy C. ; Shaw, Barbara ; Stewart, Ronald M. ; Pritchard, F. Elizabeth ; Minard, Gayle ; Kudsk, Kenneth A. ; Baselski, Vickie S. / Analysis of charges associated with diagnosis of nosocomial pneumonia : Can routine bronchoscopy be justified?. In: Journal of Trauma - Injury, Infection and Critical Care. 1994 ; Vol. 37, No. 5. pp. 721-727.
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abstract = "Many ventilated trauma patients thought to have nosocomial pneumonia have pulmonary contusion or systemic inflammatory response syndrome with tracheobronchial colonization. Fiberoptic bronchoscopy with quantitative culture techniques of protected specimen brush (PSB; threshold 103 cfu/mL) or bronchoalveolar lavage (BAL; threshold 10s cfu/mL) can potentially eliminate the false positive cultures of the upper airway seen with routine sputum aspirates (RS). However, bronchoscopy is expensive, and routine use may not be cost effective. This prospective study evaluated the patient charges associated with bronchoscopy and quantitative cultures compared with RS for the diagnosis of nosocomial pneumonia. Specimens were obtained by RS, PSB, and BAL from the lower airway in 107 trauma patients (136 sets of triplicate cultures). All patients had clinical evidence suggestive of pneumonia (fever, leukocytosis, purulent sputum, abnormal roentgenographic findings). Typical oral flora were considered contaminants; no gram-negative specimens were excluded. Mean age was 40 years and mean ISS was 29. Seventy-eight percent had blunt injuries, 22{\%} penetrating, and 42{\%} had chest injuries. The incidence of nosocomial pneumonia according to each method was: RS—73{\%}; PSB—34{\%}; BAL—25{\%}. Considering all charges involved (bronchoscopy, equipment, microbiologic analysis, and antibiotics), and based on a 14-day course of ceftazidime and vancomycin, the charges for PSB were 58{\%} of RS, and charges for BAL were 43{\%} of RS. We conclude that the charges associated with bronchoscopy are high, but can be offset by antibiotic savings. Side effects of unnecessary antibiotic therapy would be avoided. Further study is needed to determine the efficacy of PSB or BAL in trauma patients.",
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