{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:17:49Z","timestamp":1784733469899,"version":"3.55.0"},"reference-count":17,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T00:00:00Z","timestamp":1687478400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23000624_as1\"><jats:title>Objective:<\/jats:title><jats:p>To assess the accuracy of provider estimates of ventilator-associated pneumonia (VAP) diagnostic probability in various clinical scenarios.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000624_as2\"><jats:title>Design:<\/jats:title><jats:p>We conducted a clinical vignette-based survey of intensive care unit (ICU) physicians to evaluate provider estimates of VAP diagnostic probability before and after isolated cardinal VAP clinical changes and VAP diagnostic test results. Responses were used to calculate imputed diagnostic likelihood ratios (LRs), which were compared to evidence-based LRs.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000624_as3\"><jats:title>Setting:<\/jats:title><jats:p>Michigan Medicine University Hospital, a tertiary-care center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000624_as4\"><jats:title>Participants:<\/jats:title><jats:p>This study included 133 ICU clinical faculty and house staff.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000624_as5\"><jats:title>Results:<\/jats:title><jats:p>Provider estimates of VAP diagnostic probability were consistently higher than evidence-based diagnostic probabilities. Similarly, imputed LRs from provider-estimated diagnostic probabilities were consistently higher than evidence-based LRs. These differences were most notable for positive bronchoalveolar lavage culture (provider-estimated LR 5.7 vs evidence-based LR 1.4; <jats:italic>P<\/jats:italic> &lt; .01), chest radiograph with air bronchogram (provider-estimated LR 6.0 vs evidence-based LR 3.6; <jats:italic>P<\/jats:italic> &lt; .01), and isolated purulent endotracheal secretions (provider-estimated LR 1.6 vs evidence-based LR 0.8; <jats:italic>P<\/jats:italic> &lt; .01). Attending physicians and infectious disease physicians were more accurate in their LR estimates than trainees (<jats:italic>P<\/jats:italic> = .04) and non-ID physicians (<jats:italic>P<\/jats:italic> = .03).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000624_as6\"><jats:title>Conclusions:<\/jats:title><jats:p>Physicians routinely overestimated the diagnostic probability of VAP as well as the positive LRs of isolated cardinal VAP clinical changes and VAP diagnostic test results. Diagnostic stewardship initiatives, including educational outreach and clinical decision support systems, may be useful adjuncts in minimizing VAP overdiagnosis and ICU antibiotic overuse.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.62","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T01:46:41Z","timestamp":1687571201000},"page":"1927-1931","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":12,"title":["Healthcare providers consistently overestimate the diagnostic probability of ventilator-associated pneumonia"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5220-0392","authenticated-orcid":false,"given":"Nathaniel S.","family":"Soper","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1659-4902","authenticated-orcid":false,"given":"Owen R.","family":"Albin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,6,23]]},"reference":[{"key":"S0899823X23000624_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.1938"},{"key":"S0899823X23000624_ref8","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.0269"},{"key":"S0899823X23000624_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2018-000483"},{"key":"S0899823X23000624_ref10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab872"},{"key":"S0899823X23000624_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.01.013"},{"key":"S0899823X23000624_ref2","doi-asserted-by":"publisher","DOI":"10.1086\/675279"},{"key":"S0899823X23000624_ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06036-z"},{"key":"S0899823X23000624_ref16","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01332-17"},{"key":"S0899823X23000624_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-008155"},{"key":"S0899823X23000624_ref13","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.1878"},{"key":"S0899823X23000624_ref5","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2015.1289"},{"key":"S0899823X23000624_ref11","first-page":"273","article-title":"Why are antibiotics prescribed for asymptomatic bacteriuria in institutionalized elderly people? A qualitative study of physicians\u2019 and nurses\u2019 perceptions","volume":"163","author":"Walker","year":"2000","journal-title":"CMAJ"},{"key":"S0899823X23000624_ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-019-0683-8"},{"key":"S0899823X23000624_ref17","first-page":"147","article-title":"Diagnostic stewardship of endotracheal aspirate cultures in a PICU","author":"Sick-Samuels","year":"2021","journal-title":"Pediatrics"},{"key":"S0899823X23000624_ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.14.1583"},{"key":"S0899823X23000624_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-05929-3"},{"key":"S0899823X23000624_ref1","first-page":"22","article-title":"A complete and multifaceted overview of antibiotic use and infection diagnosis in the intensive care unit: results from a prospective four-year registration","author":"de Bus","year":"2018","journal-title":"Crit Care"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X23000624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,28]],"date-time":"2023-12-28T10:16:44Z","timestamp":1703758604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X23000624\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,23]]},"references-count":17,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["S0899823X23000624"],"URL":"https:\/\/doi.org\/10.1017\/ice.2023.62","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,23]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}