Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany

Spinal Cord, 2020 · DOI: https://doi.org/10.1038/s41393-020-0435-5 · Published: February 18, 2020

Spinal Cord Injury Immunology Healthcare

Simple Explanation

Spinal cord injury (SCI)-associated pneumonia (SCI-AP) is a frequent and dangerous complication after SCI. This study aims to understand how doctors in Germany diagnose and treat SCI-AP. The study surveyed SCI care departments in Germany about their clinical algorithms relevant for diagnosis and treatment of SCI-AP. The survey revealed that there are diagnostic ambiguities regarding SCI-AP even though the CDC-criteria is known and SOPs are established.

Study Duration

Not specified

Participants

61 departments for SCI-care in Germany

Evidence Level

Survey study

Key Findings

1
Awareness of diagnostic CDC-criteria for pneumonia was confirmed by 88% of departments.
2
Radiological findings, fever, and worsened gas exchange were identified as the most important factors in deciding on SCI-AP diagnosis.
3
The use of standard operating procedures (SOPs) did not significantly affect the diagnosis of SCI-AP or the request for further diagnostic parameters.

Research Summary

This survey investigates the clinical algorithms relevant for SCI-AP and analyses the utility of the CDC-criteria for the diagnosis of SCI-AP and decision-making on its therapy. The accuracy in decision-making on SCI-AP in accordance with CDC-criteria was highly varying between the case vignettes. The survey revealed that the clinical decision-making on SCI-AP in Germany is inconsistent across specialized centres for SCI-care, when compared with the CDC-criteria for ‘clinically deﬁned pneumonia’ as a reference.

Practical Implications

Need for Disease-Specific Guidelines

The heterogeneous clinical practice highlights the need for disease-specific guidelines for the diagnosis and management of SCI-AP.

Refinement of Diagnostic Criteria

CDC-criteria comprise important items for defining HAP but modifications regarding their clinical feasibility for SCI-AP are required.

Future Research Directions

International guidelines for the diagnosis of SCI-AP, factoring-in SCI-specific parameters of the individual susceptibility for neurogenic immune depression (SCI-IDS), are needed to develop and compare future advances to reduce SCI-AP.

Study Limitations

1
The number of vignettes is restricted.
2
The variability of CDC-criteria is limited.
3
The 38% response rate of this paper-based survey is not meeting the 70% benchmark for mail surveys

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