STUDY DESIGN Survey study. OBJECTIVES Spinal cord injury (SCI)-associated pneumonia (SCI-AP) is associated with poor functional recovery and a major cause of death after SCI. Better tackling SCI-AP requires a common understanding on how SCI-AP is defined. This survey examines clinical algorithms relevant for diagnosis and treatment of SCI-AP. SETTING All departments for SCI-care in Germany. METHODS The clinical decision-making on SCI-AP and the utility of the Centers for Disease Control and Prevention (CDC) criteria for diagnosis of 'clinically defined pneumonia' were assessed by means of a standardized questionnaire including eight case vignettes of suspected SCI-AP. The diagnostic decisions based on the case information were analysed using classification and regression trees (CART). RESULTS The majority of responding departments were aware of the CDC-criteria (88%). In the clinical vignettes, 38-81% of the departments diagnosed SCI-AP in accordance with the CDC-criteria and 7-41% diagnosed SCI-AP in deviation from the CDC-criteria. The diagnostic agreement was not associated with the availability of standard operating procedures for SCI-AP management in the departments. CART analysis identified radiological findings, fever, and worsened gas exchange as most important for the decision on SCI-AP. Frequently requested supplementary diagnostics were microbiological analyses, C-reactive protein, and procalcitonin. For empirical antibiotic therapy, the departments used (acyl-)aminopenicillins/β-lactamase inhibitors, cephalosporins, or combinations of (acyl-)aminopenicillins/β-lactamase inhibitors with fluoroquinolones or carbapenems. CONCLUSIONS This survey reveals a diagnostic ambiguity regarding SCI-AP despite the awareness of CDC-criteria and established SOPs. Heterogeneous clinical practice is encouraging the development of disease-specific guidelines for diagnosis and management of SCI-AP.

中文翻译：

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脊髓损伤相关性肺炎的临床决策：德国的一项全国性调查。

研究设计调查研究。目的脊髓损伤（SCI）相关的肺炎（SCI-AP）与功能恢复差和SCI后死亡的主要原因有关。更好地处理SCI-AP需要对如何定义SCI-AP达成共识。这项调查研究了与SCI-AP的诊断和治疗相关的临床算法。设置德国SCI护理的所有部门。方法通过标准化问卷调查，评估SCI-AP的临床决策以及疾病控制和预防中心（CDC）诊断“临床定义的肺炎”的标准，其中包括八例疑似SCI-AP病例。使用分类和回归树（CART）分析了基于病例信息的诊断决策。结果大多数响应部门都知道CDC标准（88％）。在临床渐晕中，有38-81％的部门根据CDC标准诊断出SCI-AP，而7-41％的部门诊断出偏离CDC标准的SCI-AP。诊断协议与部门中SCI-AP管理的标准操作程序的可用性无关。CART分析确定了放射学发现，发烧和恶化的气体交换是决定SCI-AP的最重要因素。经常需要的补充诊断是微生物分析，C反应蛋白和降钙素。对于经验性抗生素治疗，部门使用（酰基-）氨基青霉素/β-内酰胺酶抑制剂，头孢菌素，或（酰基-）氨基青霉素/β-内酰胺酶抑制剂与氟喹诺酮或碳青霉烯类的组合。结论尽管对CDC标准和既定的SOP有所了解，但本调查显示了关于SCI-AP的诊断含糊。异构临床实践正在鼓励制定针对SCI-AP的疾病特定指南。