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{{Community-acquired pneumonia}}
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{{CMG}}
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==Overview==
Several criteria have been studied to assess the severity, prognosis, and need for hospital admission among patients presenting with symptoms suggestive of community acquired pneumonia (CAP). Of those, the pneumonia severity index (PSI), the CURB65, and the IDSA/ATS criteria for severe CAP are among the more widely employed diagnostic/prognostic schemes.
==The Pneumonia Severity Index (PSI)==
The [[pneumonia]] severity index is a clinical prediction rule that [[medicine|medical practitioners]] can use to calculate the probability of [[morbidity]] and [[death|mortality]] among patients with [[community acquired pneumonia]].<ref name="pmid8995086">Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. ''N Engl J Med''. 1997 Jan 23;336(4):243–250. PMID 8995086</ref>
===Development of the PSI===
The rule uses [[demographics]] (whether someone is older, and is male or female), the coexistence of core morbid illnesses, findings on [[physical examination]] and [[vital signs]], and essential laboratory findings.  This study demonstrated that patients could be stratified into five risk categories, Risk Classes I-V, and that these classes could be used to predict 30-day survival. 
===Data Source for Derivation and Validation===
The rule was derived then validated with data from 38,000 patients from the MedisGroup Cohort Study for 1989, comprising 1 year of data from 257 hospitals across the US who used the MedisGroup patient outcome tracking software built and serviced by Mediqual Systems ([[Cardinal Health]]). One significant caveat to the data source was that patients who were discharged home or transferred from the MedisGroup hospitals could not be followed at the 30-day mark, and were therefore assumed to be "alive" at that time.  Further validation was performed with the Pneumonia Patient Outcomes Research Team [PORT] (1991) cohort study.  This categorization method has been replicated by others<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref> and is comparable to the [[CURB-65]] in predicting mortality.<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref>
===Usage and Application of the PSI===
The purpose of the PSI is to classify the severity of a patient's pneumonia to determine the amount of resources to be allocated for care.  Most commonly, the PSI scoring system has been used to decide whether patients with pneumonia can be treated as outpatients or as (hospitalized) inpatients. A '''Risk Class I''' pneumonia patient can be sent home on oral antibiotics. A Risk Class II-III pneumonia patient may be sent home with IV antibiotics or treated and monitored for 24 hours in hospital.  Patients with Risk Class IV-V pneumonia patient should be hospitalized for treatment.
===The PSI Algorithm===
The PSI Algorithm is detailed below.  An [http://pda.ahrq.gov/clinic/psi/psicalc.asp online, automated PSI calculator] is available on the US [[AHRQ]] website.
<div style="font-size:90%">
{{familytree/start}}
{{familytree | | | | A01 | | | | | | | A01=<div style="float: left; text-align: center; width: 18em; padding:0.5em;">'''Step 1'''</div><div style="float: left; text-align: left; width: 18em; padding:0.5em;">
----
'''Does the patient has any of the following conditions?'''
* >50 years of age
* Altered mental status
* Pulse ≥125/minute
* Respiratory rate >30/minute
* Systolic blood pressure ≥90 mm Hg
* Temperature <35°C or ≥40°C
* Neoplastic disease
* Congestive heart failure
* Cerebrovascular disease
* Renal disease
* Liver disease</div>}}
{{familytree | |,|-|-|^|-|-|.| | | | | | |}}
{{familytree | B01 | | | | B02 | | | | B01=<div style="float: left; text-align: center; width: 10em; padding:0.5em;">'''No'''
----
'''Risk Class I''' </div> |B02=<div style="float: left; text-align: center; width: 23em; padding:0.5em;">'''Yes''' </div> }}
{{familytree | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | C01 | | | | | | C01=<div style="float: left; text-align: center; width: 23em; padding:0.5em;">'''Step 2'''
----
'''Assess the following conditions and assign the corresponding scores:'''<div style="font-size:90%;">
{{#widget:BlueTable2}}<table class="BlueTable2">
<tr class="v-firstrow"><th>Condition </th><th>Points </th></tr>
<tr><td>If Male</td><td>+Age (yrs) </td></tr>
<tr><td>If Female</td><td>+Age (yrs) - 10</td></tr>
<tr><td>Nursing home resident </td><td> +10</td></tr>
<tr><td>Neoplastic disease </td><td>+30 </td></tr>
<tr><td>Liver disease </td><td>+20 </td></tr>
<tr><td>Congestive heart failure </td><td>+10 </td></tr>
<tr><td>Cerebrovascular disease </td><td>+10</td></tr>
<tr><td>Renal disease </td><td>+10 </td></tr>
<tr><td>Altered mental status</td><td>+20 </td></tr>
<tr><td>Pulse ≥125/minute </td><td>+20 </td></tr>
<tr><td>Respiratory rate >30/minute </td><td>+20 </td></tr>
<tr><td>Systolic blood pressure ≥90 mm Hg </td><td>+15 </td></tr>
<tr><td>Temperature <35°C or ≥40°C </td><td>+10 </td></tr>
<tr><td>Arterial pH <7.35 </td><td> +30</td></tr>
<tr><td>Blood urea nitrogen ≥30 mg/dl (9 mmol/liter) </td><td>+20 </td></tr>
<tr><td>Sodium <90 mmol/liter</td><td> +20</td></tr>
<tr><td>Glucose ≥250 mg/dl (14 mmol/liter)</td><td>+10 </td></tr>
<tr><td>Hematocrit <30%</td><td>+10 </td></tr>
<tr><td>Partial pressure of arterial O2 <60mmHg </td><td>+10 </td></tr>
<tr><td>Pleural effusion </td><td>+10 </td></tr>
</table></div>
</div>}}
{{familytree | |,|-|-|v|-|-|^|-|v|-|-|.| | }}
{{familytree | D01 | |D02 | | D03| | D04 | |D01=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''∑ <70 = Risk Class II''' </div> |D02=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''∑ 71-90 = Risk Class III''' </div> |D03=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''∑ 91-130 = Risk Class IV'''</div> |D04=<div style="float: left; text-align: center; width: 12em; padding:0.5em;">'''∑ >130 = Risk Class V''' </div> }}
{{familytree/end}}</div>
===PSI Derivation and Validation Data===
{{#widget:BlueTable}}
{| class="BlueTable"
|- style="font-size:12pt"
! width="74" height="16"  valign="bottom" | 
!style="font-weight:bold" width="52" colspan="4" align="center" valign="bottom" | Medisgroup Study (1989)
!style="font-weight:bold" width="52" colspan="6" align="center" valign="bottom" | PORT Validation Study (1991) Cohort
|-  valign="bottom"
!style="font-size:12pt" height="16" | 
!style="font-size:11pt;font-weight:bold" colspan="2" | Derivation Cohort
!style="font-size:11pt;font-weight:bold" colspan="2"| Validation Cohort
!style="font-size:11pt;font-weight:bold" colspan="2"| Inpatients
!style="font-size:11pt;font-weight:bold" colspan="2"| Outpatients
!style="font-size:11pt;font-weight:bold" colspan="2"| All Patients
|- style="font-weight:bold"  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold"| Risk Class
|style="background-color:#C0C0C0;font-weight:bold"| no. of pts
|style="background-color:#C0C0C0;font-weight:bold"| % died
|style="background-color:#C0C0C0;font-weight:bold"| no. of pts
|style="background-color:#C0C0C0;font-weight:bold"| % died
|style="background-color:#C0C0C0;font-weight:bold"| no. of pts
|style="background-color:#C0C0C0;font-weight:bold"| % died
|style="background-color:#C0C0C0;font-weight:bold"| no. of pts
|style="background-color:#C0C0C0;font-weight:bold"| % died
|style="background-color:#C0C0C0;font-weight:bold"| no. of pts
|style="background-color:#C0C0C0;font-weight:bold"| % died
|-  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold" height="15" |  I 
|  1,372 
|  0.4 
|  3,034 
|  0.1 
|  185 
|  0.5 
|  587 
|  0.0 
|  772 
|  0.1 
|-  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold" height="15" |  II (<70) 
|  2,412 
|  0.7 
|  5,778 
|  0.6 
|  233 
|  0.9 
|  244 
|  0.4 
|  477 
|  0.6 
|-  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold" height="15" |  III (71–90) 
|  2,632 
|  2.8 
|  6,790 
|  2.8 
|  254 
|  1.2 
|  72 
|  0.0 
|  326 
|  0.9 
|-  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold" height="15" |  IV (91–130) 
|  4,697 
|  8.5 
|  13,104 
|  8.2 
|  446 
|  9.0 
|  40 
|  12.5 
|  486 
|  9.3 
|-  valign="bottom"
|style="background-color:#C0C0C0;font-weight:bold" height="15" |  V (>130) 
|  3,086 
|  31.1 
|  9,333 
|  29.2 
|  225 
|  27.1 
|  1 
|  0.0 
|  226 
|  27.0 
|-  valign="bottom"
|style="font-weight:bold" height="15" |  Total 
|  '''14,199''' 
|  10.2 
| '''38,039''' 
|  10.6 
|  '''1343''' 
|  8.0 
|  '''944''' 
|  0.6 
|  '''2287''' 
|  5.2 
|}
Note: % Died refers to 30-day mortality.
==The CURB65 Clinical Prediction Rule==
CURB-65 is a [[clinical prediction rule]] that has been validated for predicting mortality in [[community-acquired pneumonia]]<ref name="pmid12728155">{{cite journal |author=Lim WS, van der Eerden MM, Laing R, ''et al'' |title=Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study |journal=Thorax |volume=58 |issue=5 |pages=377-82 |year=2003 |pmid=12728155 |doi=}}</ref> and infection of any site<ref name="pmid17576773">{{cite journal |author=Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI |title=Performance of severity of illness scoring systems in emergency department patients with infection |journal=Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |volume=14 |issue=8 |pages=709-14 |year=2007 |pmid=17576773 |doi=10.1197/j.aem.2007.02.036}}</ref>. The CURB-65 is based on the earlier CURB score<ref name="pmid11254821">{{cite journal |author=Lim WS, Macfarlane JT, Boswell TC, ''et al'' |title=Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines |journal=Thorax |volume=56 |issue=4 |pages=296-301 |year=2001 |pmid=11254821 |doi=}}</ref> and is recommended by the [[British Thoracic Society]] for the assessment of severity of pneumonia.<ref name="pmid11713364">{{cite journal |author= |title=BTS Guidelines for the Management of Community Acquired Pneumonia in Adults |journal=Thorax |volume=56 Suppl 4 |issue= |pages=IV1-64 |year=2001 |pmid=11713364 |doi=}}</ref>
===CURB-65===
The score is an [[Wiktionary:acronym|acronym]] for each of the risk factors measured.  Each risk factor scores one point, for a maximum score of 5:
* Confusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less)
* Urea greater than 7 mmol/l (Blood Urea Nitrogen > 20)
* Respiratory rate of 30 breaths per minute or greater
* Blood pressure less than 90 systolic or diastolic blood pressure 60 or less
* Age 65 or older
===Predicting Death from Pneumonia===
The risk of death increases as the score increases.
{| style="border: 0px; font-size: 85%; margin: 3px; width:200px;" align=center
|valign=top|
|+
! style="background: #4479BA; color:#FFF;  width: 200px;" | CURB-65 Score 
! style="background: #4479BA; color:#FFF;  width: 200px;" | Risk of death
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" |  0
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |0.7%
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 1
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |3.2%
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" |  2
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |13.0%
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" |  3
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |17.0%
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" |  4
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |41.5%
|-
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" |  5
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |57.0%
|}
The CURB-65 has been compared to the [[pneumonia severity index]] in predicting mortality from pneumonia.<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref>
===Predicting Death from Any Infection===
A [[cohort study]] of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases<ref name="pmid17576773"/>:
* 0 to 1 <5% mortality
* 2 to 3 < 10% mortality
* 4 to 5 15-30% mortality
==Infectious Diseases Society of America/American Thoracic Society Consensus Recommendation Criteria for Severe Community Acquired Pneumonia in Adults<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref>==
====Major Criteria====
* Invasive [[mechanical ventilation]]
* [[Septic shock]] with the need for [[vasopressors]]
====Minor Criteria====


==Overview==
==Criteria for Severe Community Acquired Pneumonia==
==Infectious Diseases Society of America/American Thoracic Society consensus recommendation criteria for severe community acquired pneumonia in adults. <ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> (DO NOT EDIT)==


{{lquote|
===Minor criteria===
* Respiratory rate >30 breaths/min
* Respiratory rate >30 breaths/min
* PaO2/FiO2 ratio <250
* PaO2/FiO2 ratio <250
Line 18: Line 249:
* [[Hypothermia]] (core temperature, <36 degrees C)
* [[Hypothermia]] (core temperature, <36 degrees C)
* [[Hypotension]] requiring aggressive fluid resuscitation
* [[Hypotension]] requiring aggressive fluid resuscitation
===Major criteria===
 
* Invasive [[mechanical ventilation]]
==Clinical Prediction Rule for Predicting Pulmonary Infiltrates Based on Clinical Findings==
* [[Septic shock]] with the need for [[vasopressors]]
 
}}
A [[clinical prediction rule]] found the five following signs from the medical history and [[physical examination]] best predicted infiltrates on the chest [[radiography|radiograph]] of 1134 patients presenting to an emergency room:<ref name="pmid2221647">{{cite journal |author=Heckerling PS, Tape TG, Wigton RS, ''et al'' |title=Clinical prediction rule for pulmonary infiltrates |journal=Ann. Intern. Med. |volume=113|issue=9 |pages=664–70 |year=1990 |pmid=2221647 |doi=}}</ref>
 
* Temperature > 100 degrees F (37.8 degrees C)
* Pulse > 100 beats/min
* [[Rales|Crackles]]
* Decreased [[breath sound]]s
* Absence of [[asthma]]
 
{| class="wikitable"
|+ Probability of an Infiltrate <BR> Based on the Number of Findings
! Number of Findings
! Primary Care
! Emergency Room
|-
| 5 || 47% || 75%
|-
| 4 || 27 || 56
|-
| 3 || 8 || 22
|-
| 2 || 4 || 11
|-
| 1 || 1 || 3
|-
| 0 || 1|| 2
|}


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]
[[Category:Pneumonia]]
[[Category:Pneumonia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 21:02, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Several criteria have been studied to assess the severity, prognosis, and need for hospital admission among patients presenting with symptoms suggestive of community acquired pneumonia (CAP). Of those, the pneumonia severity index (PSI), the CURB65, and the IDSA/ATS criteria for severe CAP are among the more widely employed diagnostic/prognostic schemes.

The Pneumonia Severity Index (PSI)

The pneumonia severity index is a clinical prediction rule that medical practitioners can use to calculate the probability of morbidity and mortality among patients with community acquired pneumonia.[1]

Development of the PSI

The rule uses demographics (whether someone is older, and is male or female), the coexistence of core morbid illnesses, findings on physical examination and vital signs, and essential laboratory findings. This study demonstrated that patients could be stratified into five risk categories, Risk Classes I-V, and that these classes could be used to predict 30-day survival.

Data Source for Derivation and Validation

The rule was derived then validated with data from 38,000 patients from the MedisGroup Cohort Study for 1989, comprising 1 year of data from 257 hospitals across the US who used the MedisGroup patient outcome tracking software built and serviced by Mediqual Systems (Cardinal Health). One significant caveat to the data source was that patients who were discharged home or transferred from the MedisGroup hospitals could not be followed at the 30-day mark, and were therefore assumed to be "alive" at that time. Further validation was performed with the Pneumonia Patient Outcomes Research Team [PORT] (1991) cohort study. This categorization method has been replicated by others[2] and is comparable to the CURB-65 in predicting mortality.[2]

Usage and Application of the PSI

The purpose of the PSI is to classify the severity of a patient's pneumonia to determine the amount of resources to be allocated for care. Most commonly, the PSI scoring system has been used to decide whether patients with pneumonia can be treated as outpatients or as (hospitalized) inpatients. A Risk Class I pneumonia patient can be sent home on oral antibiotics. A Risk Class II-III pneumonia patient may be sent home with IV antibiotics or treated and monitored for 24 hours in hospital. Patients with Risk Class IV-V pneumonia patient should be hospitalized for treatment.

The PSI Algorithm

The PSI Algorithm is detailed below. An online, automated PSI calculator is available on the US AHRQ website.

 
 
 
Step 1

Does the patient has any of the following conditions?

  • >50 years of age
  • Altered mental status
  • Pulse ≥125/minute
  • Respiratory rate >30/minute
  • Systolic blood pressure ≥90 mm Hg
  • Temperature <35°C or ≥40°C
  • Neoplastic disease
  • Congestive heart failure
  • Cerebrovascular disease
  • Renal disease
  • Liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
Risk Class I
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Step 2
Assess the following conditions and assign the corresponding scores:
Condition Points
If Male+Age (yrs)
If Female+Age (yrs) - 10
Nursing home resident +10
Neoplastic disease +30
Liver disease +20
Congestive heart failure +10
Cerebrovascular disease +10
Renal disease +10
Altered mental status+20
Pulse ≥125/minute +20
Respiratory rate >30/minute +20
Systolic blood pressure ≥90 mm Hg +15
Temperature <35°C or ≥40°C +10
Arterial pH <7.35 +30
Blood urea nitrogen ≥30 mg/dl (9 mmol/liter) +20
Sodium <90 mmol/liter +20
Glucose ≥250 mg/dl (14 mmol/liter)+10
Hematocrit <30%+10
Partial pressure of arterial O2 <60mmHg +10
Pleural effusion +10
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
∑ <70 = Risk Class II
 
∑ 71-90 = Risk Class III
 
∑ 91-130 = Risk Class IV
 
∑ >130 = Risk Class V
 

PSI Derivation and Validation Data

Medisgroup Study (1989) PORT Validation Study (1991) Cohort
Derivation Cohort Validation Cohort Inpatients Outpatients All Patients
Risk Class no. of pts % died no. of pts % died no. of pts % died no. of pts % died no. of pts % died
I 1,372 0.4 3,034 0.1 185 0.5 587 0.0 772 0.1
II (<70) 2,412 0.7 5,778 0.6 233 0.9 244 0.4 477 0.6
III (71–90) 2,632 2.8 6,790 2.8 254 1.2 72 0.0 326 0.9
IV (91–130) 4,697 8.5 13,104 8.2 446 9.0 40 12.5 486 9.3
V (>130) 3,086 31.1 9,333 29.2 225 27.1 1 0.0 226 27.0
Total 14,199 10.2 38,039 10.6 1343 8.0 944 0.6 2287 5.2

Note: % Died refers to 30-day mortality.

The CURB65 Clinical Prediction Rule

CURB-65 is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia[3] and infection of any site[4]. The CURB-65 is based on the earlier CURB score[5] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[6]

CURB-65

The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:

  • Confusion (defined as an AMT of 8 or less)
  • Urea greater than 7 mmol/l (Blood Urea Nitrogen > 20)
  • Respiratory rate of 30 breaths per minute or greater
  • Blood pressure less than 90 systolic or diastolic blood pressure 60 or less
  • Age 65 or older

Predicting Death from Pneumonia

The risk of death increases as the score increases.

CURB-65 Score Risk of death
0 0.7%
1 3.2%
2 13.0%
3 17.0%
4 41.5%
5 57.0%

The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia.[2]

Predicting Death from Any Infection

A cohort study of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases[4]:

  • 0 to 1 <5% mortality
  • 2 to 3 < 10% mortality
  • 4 to 5 15-30% mortality

Infectious Diseases Society of America/American Thoracic Society Consensus Recommendation Criteria for Severe Community Acquired Pneumonia in Adults[7]

Major Criteria

Minor Criteria

Clinical Prediction Rule for Predicting Pulmonary Infiltrates Based on Clinical Findings

A clinical prediction rule found the five following signs from the medical history and physical examination best predicted infiltrates on the chest radiograph of 1134 patients presenting to an emergency room:[8]

Probability of an Infiltrate
Based on the Number of Findings
Number of Findings Primary Care Emergency Room
5 47% 75%
4 27 56
3 8 22
2 4 11
1 1 3
0 1 2

References

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