Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment
Abstract Objective: Ventilator-associated pneumonia (VAP) can be overdiagnosed on the basis of positive respiratory cultures in the absence of clinical findings of pneumonia. We determined the perceived diagnostic importance of 6 clinical attributes in ordering a respiratory culture to identify op...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2022-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X22002674/type/journal_article |
| _version_ | 1811157151625773056 |
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| author | Blaine Kenaa Nathan N. O’Hara Lyndsay M. O’Hara Kimberly C. Claeys Surbhi Leekha |
| author_facet | Blaine Kenaa Nathan N. O’Hara Lyndsay M. O’Hara Kimberly C. Claeys Surbhi Leekha |
| author_sort | Blaine Kenaa |
| collection | DOAJ |
| description |
Abstract
Objective:
Ventilator-associated pneumonia (VAP) can be overdiagnosed on the basis of positive respiratory cultures in the absence of clinical findings of pneumonia. We determined the perceived diagnostic importance of 6 clinical attributes in ordering a respiratory culture to identify opportunities for diagnostic stewardship.
Design:
A discrete choice experiment presented participants with a vignette consisting of the same “stem” plus variations in 6 clinical attributes associated with VAP: chest imaging, oxygenation, sputum, temperature, white blood cell count, and blood pressure. Each attribute had 3–4 levels, resulting in 32 total scenarios. Participants indicated whether they would order a respiratory culture, and if yes, whether they preferred the bronchoalveolar lavage or endotracheal aspirate sample-collection method. We calculated diagnostic utility of attribute levels and relative importance of each attribute.
Setting and participants:
The survey was administered electronically to critical-care clinicians via a Qualtrics survey at a tertiary-care academic center in the United States.
Results:
In total, 59 respondents completed the survey. New radiograph opacity (utility, 1.15; 95% confidence interval [CI], 0.99–1.3), hypotension (utility, 0.88; 95% CI, 0.74–1.03), fever (utility, 0.76; 95% CI, 0.62–0.91) and copious sputum (utility, 0.75; 95% CI, 0.60–0.90) had the greatest perceived diagnostic value that favored ordering a respiratory culture. Radiograph changes (23%) and temperature (20%) had the highest relative importance. New opacity (utility, 0.35; 95% CI, 0.17–0.52) and persistent opacity on radiograph (utility, 0.32; 95% CI, 0.05–0.59) had the greatest value favoring bronchoalveolar lavage over endotracheal aspirate.
Conclusion:
Perceived high diagnostic value of fever and hypotension suggest that sepsis vigilance may drive respiratory culturing and play a role in VAP overdiagnosis.
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| first_indexed | 2024-04-10T05:02:11Z |
| format | Article |
| id | doaj.art-2eae9650a4044d61a7d85ea4558e608e |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:02:11Z |
| publishDate | 2022-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-2eae9650a4044d61a7d85ea4558e608e2023-03-09T12:28:16ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2022-01-01210.1017/ash.2022.267Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experimentBlaine Kenaa0https://orcid.org/0000-0001-9421-121XNathan N. O’Hara1https://orcid.org/0000-0003-0537-3474Lyndsay M. O’Hara2Kimberly C. Claeys3Surbhi Leekha4Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MarylandDepartment of Orthopaedics, University of Maryland School of Medicine, Baltimore, MarylandDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MarylandDepartment of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Abstract Objective: Ventilator-associated pneumonia (VAP) can be overdiagnosed on the basis of positive respiratory cultures in the absence of clinical findings of pneumonia. We determined the perceived diagnostic importance of 6 clinical attributes in ordering a respiratory culture to identify opportunities for diagnostic stewardship. Design: A discrete choice experiment presented participants with a vignette consisting of the same “stem” plus variations in 6 clinical attributes associated with VAP: chest imaging, oxygenation, sputum, temperature, white blood cell count, and blood pressure. Each attribute had 3–4 levels, resulting in 32 total scenarios. Participants indicated whether they would order a respiratory culture, and if yes, whether they preferred the bronchoalveolar lavage or endotracheal aspirate sample-collection method. We calculated diagnostic utility of attribute levels and relative importance of each attribute. Setting and participants: The survey was administered electronically to critical-care clinicians via a Qualtrics survey at a tertiary-care academic center in the United States. Results: In total, 59 respondents completed the survey. New radiograph opacity (utility, 1.15; 95% confidence interval [CI], 0.99–1.3), hypotension (utility, 0.88; 95% CI, 0.74–1.03), fever (utility, 0.76; 95% CI, 0.62–0.91) and copious sputum (utility, 0.75; 95% CI, 0.60–0.90) had the greatest perceived diagnostic value that favored ordering a respiratory culture. Radiograph changes (23%) and temperature (20%) had the highest relative importance. New opacity (utility, 0.35; 95% CI, 0.17–0.52) and persistent opacity on radiograph (utility, 0.32; 95% CI, 0.05–0.59) had the greatest value favoring bronchoalveolar lavage over endotracheal aspirate. Conclusion: Perceived high diagnostic value of fever and hypotension suggest that sepsis vigilance may drive respiratory culturing and play a role in VAP overdiagnosis. https://www.cambridge.org/core/product/identifier/S2732494X22002674/type/journal_article |
| spellingShingle | Blaine Kenaa Nathan N. O’Hara Lyndsay M. O’Hara Kimberly C. Claeys Surbhi Leekha Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment |
| title_full | Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment |
| title_fullStr | Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment |
| title_full_unstemmed | Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment |
| title_short | Understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia: A discrete choice experiment |
| title_sort | understanding healthcare provider preferences for ordering respiratory cultures to diagnose ventilator associated pneumonia a discrete choice experiment |
| url | https://www.cambridge.org/core/product/identifier/S2732494X22002674/type/journal_article |
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