"So I think if we’re going to remove the chest x-ray from our definition, whether it’s from surveillance or from the definition that we use clinically, we have to have data to support that it shouldn’t be there."
Dr. Evans said the chest x-ray report from the day after BAL was included to help train the classifier to be accurate, and that the finding of statistical significance only for that day’s chest x-ray report data was unexpected and provocative.
Dr. Pamela Lipsett
Dr. Pamela Lipsett, immediate past president of the Surgical Infection Society, was involved in the CDC’s redefinition of what is now termed ventilator-associated events. She argued against the use of chest x-rays for VAP diagnosis and said they were removed from the CDC definition because they are unreliable.
Some attendees questioned why the authors didn’t just use a structured method for reading the radiographs. Dr. E. Patchen Dellinger, also a past president of the Society, simply asked, "Haven’t you just proved that we don’t know how to diagnosis VAP and that we should stop taking chest x-rays unless we’re worried about a pneumothorax?"
Dr. Evans replied that there are many other indications for chest x-ray in the ICU, but added that "the days of getting a chest x-ray every morning just because the patient is ventilated are a gross overuse of that imaging modality."
The authors reported no relevant conflicts of interest.