Pneumonia - Hospital-Acquired Initial Assessment

Last updated: 30 June 2025

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Clinical Presentation

Content on this page:

Clinical Presentation

Clinical Presentation

Pneumonia - Hospital-Acquired_Initial AssesmentPneumonia - Hospital-Acquired_Initial Assesment




Typical Signs and Symptoms of Hospital-Acquired Pneumonia

  • Fever
  • Cough with or without sputum production
  • Purulent sputum
  • Dyspnea, shortness of breath
  • Respiratory failure

Other Findings

  • Worsening oxygenation
  • Increased heart rate
  • Increased minute ventilation

Diagnosis or Diagnostic Criteria

A thorough history and physical examination are performed to determine the severity of pneumonia. These can elicit the presence of specific conditions that can have an impact on the likely pathogens and exclude other potential sources of infection.  

The clinical approach to defining pneumonia makes use of clinical evidence and radiographic findings. Clinical Pulmonary Infection Score (CPIS) is used to quantify clinical, radiographic, microbiologic, and physiological findings. A threshold score of >6 leads to a diagnosis of HAP. This may be useful in selecting patients for short-course antibiotic therapy and monitoring of response to treatment.

CLINICAL PULMONARY INFECTION SCORE (CPIS)
Diagnostic Feature


 CPIS Points
0 1 2 
Tracheal secretions Rare Abundant Abundant and purulent 
Chest X-ray infiltrate None  Diffuse  Localized 
Temperature (°C) ≥36.5 and ≤38.4  ≥38.5 and ≤38.9  ≥39 or ≤36 
White blood cells (×109/L)  ≥4.0 and ≤11.0  <4.0 or >11.0  <4.0 or >11.0 plus band forms ≥0.5
 PaO2/FiO2 mmHg >240 or ARDS   - ≤240 and no ARDS 
 Microbiology Negative Positive Positive + positive Gram stain
Reference: Rotstein C, Evans G, Born A, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008 Jan;19(1):19-53.

The modified CPIS includes all the parameters under CPIS except microbiological information. This is also used in the clinical decision-making process prior to initiating antibiotic therapy and assessment of treatment response and antibiotic de-escalation.