Comparing clinical assessments of pneumonia to bronchoalveolar lavage results in critically ill patients with suspected pneumonia

作者：Caroline F. Zhao, Chong Gao, Helen K Donnelly, Erin A Korth, Francisco Martínez, Bridget A. Giblin, Leslie Pinzon, Katie Clepp, Wan-Ting Liao, Nandita R. Nadig, Benjamin D Singer, Richard G Wunderink, Chiagozie I Pickens · 发表于：Annals of the American Thoracic Society · 年份：2026 · DOI：10.1093/annalsats/aaoag050 · 被引用次数：1 · 研究领域：Nosocomial Infections in ICU、Pneumonia and Respiratory Infections、Antibiotic Use and Resistance

RATIONALE: While clinical criteria are used to diagnose pneumonia in critically ill patients, rates of concordance between a clinician's suspicion for pneumonia and a diagnosis of lower respiratory tract infection using bronchoalveolar lavage (BAL) results are undefined. OBJECTIVES: To assess rates of concordance between clinically suspected pneumonia and pneumonia diagnosed by BAL and clinical adjudication in mechanically ventilated patients undergoing BAL for suspected pneumonia, and to identify clinical factors and outcomes associated with diagnostic discordance. METHODS: This was a single-center prospective observational study of intubated, mechanically ventilated patients undergoing BAL for suspected pneumonia. From 2018 to 2022, clinicians were asked to quantify their suspicion for pneumonia on the same day they performed a BAL for the patient with one of the following options: <15%, 30%, 50%, 70%, or >85%. Responses were categorized as low (<15% to 30%), intermediate (50%), or high (70% to >85%) suspicion for pneumonia and compared to diagnoses of pneumonia based on independent adjudication of clinical data plus BAL results. RESULTS: Among 659 patients, 84% (553/659) were adjudicated to have pneumonia based on chart review and BAL results. Clinicians assigned a low suspicion for pneumonia to 20% (109/553) of patients with an adjudicated diagnosis of pneumonia. Clinicians assigned a high suspicion for pneumonia in 28% (30/106) of patients without pneumonia based on adju...