A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia

Buising, Kirsty; Thursky, Karin; Black, Jim; MacGregor, Lachlan; Street, Alan; Kennedy, Marcus P.; Brown, Graham V.

doi:10.1136/thx.2005.051326

Cited by 194 publications

(138 citation statements)

References 22 publications

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“…Only class I of the recalibrated PSI score can therefore be used to identify patients who qualify for outpatient management. Prior validation studies have prospectively evaluated severity scores in different clinical settings and reported high mortality rates particularly in patients of PSI class III or above and CURB65 class 1 or above [10][11][12][13][14][15][16][17]. These studies, however, focused mainly on the overall discriminatory ability of the prediction rules with varying results as expressed by differences in the area under the ROC curves.…”

Section: Discussionmentioning

confidence: 99%

“…With only few exceptions [10], external validation studies of pneumonia severity scores have focused on discriminative properties, i.e. the ability of the score to distinguish patients with CAP and fatal outcome from those surviving [10][11][12][13][14][15][16][17]. Despite good discriminatory abilities, most validation studies found higher mortality rates of patients with PSI class III and CURB65 class 1 than was reported in the original studies.…”

Section: Introductionmentioning

confidence: 99%

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Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

et al. 2008

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SUMMARYIn patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept a and the calibration slope b from our calibration model. Each of the original models underestimated the observed 30-day mortality of 11 %, in 371 patients admitted to the emergency department with CAP (8 . 4%, 5 . 5 % and 5 . 0% for the PSI, CURB65 and CRB65 scores, respectively). In particular, we observed a relevant mortality within the low risk classes of the original models (2 . 6%, 5 . 3%, and 3 . 7% for PSI classes I-III, CURB65 classes 0-1, and CRB65 class 0, respectively). Recalibration of the original risk models corrected the miscalibration. After recalibration, however, only PSI class I was sensitive enough to identify patients with a low risk (i.e. <1%) for mortality suitable for outpatient management. In our tertiary-care setting with mostly referred in-patients, CAP risk scores substantially underestimated observed mortalities misclassifying patients with relevant risks of death suitable for outpatient management. Prior to the implementation of CAP risk scores in the clinical setting, the need for recalibration and the accuracy of low-risk re-classification should be studied in order to adhere with discharge guidelines and guarantee patients' safety.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

et al. 2008

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“…Similar a lo descrito por otros autores, los cuatro índices pronósticos (PSI, CURB-65, SMART-COP y SCAP) se relacionaron significativamente con la permanencia en el hospital [29][30][31][32] . De hecho, las categorías de alto riesgo se asociaron a estancia prolongada en el hospital (Tabla 5).…”

Section: Discussionunclassified

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

et al. 2017

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“…Los índices pronósticos validados en la literatura científi ca (IGN, CURB-65 e INGAC) permiten estratifi car apropiadamente a los pacientes que requieren ventilación mecánica 29,32 . Similar a lo descrito por España y cols 31 , el INGAC fue más sensible y específi co en la pesquisa de pacientes con falla respiratoria grave que requirieron conexión a ventilador mecánico.…”

Section: Artículo Originalunclassified

“…Similar a lo descrito por otros autores, los tres índices pronósticos (IGN, CURB-65 e INGAC) se relacionaron signifi cativamente con la permanencia en el hospital 29,31,32 . De hecho, las categorías de alto riesgo se asociaron a estancia prolongada en el hospital (Tabla 5).…”

Section: Artículo Originalunclassified

Índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía neumocóccica adquirida en la comunidad

P²

2011

Rev. chil. infectol.

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Streptococcus pneumoniae is the main cause of community-acquired pneumonia (CAP) in adults. Objectives: To compare accuracy and discriminatory power of three validated rules for predicting clinically relevant adverse outcomes in patients hospitalized with community-acquired pneumococcal pneumonia. Measurements: We prospectively compared the pneumonia severity index (PSI), British Thoracic Society score (CURB-65) and severe CAP score (SCAP) in a cohort of 151 consecutive immunocompetent adult patients hospitalized with pneumococcal pneumonia. Major adverse outcomes were admission to ICU, need for mechanical ventilation, in-hospital complications and 30-day mortality. Mean hospital length of stay (LOS) was also evaluated. The predictive indexes were compared based on sensitivity, specifi city, and area under the curve of the receiver operating characteristic. Results: The mean age of 151 immunocompetent adult patients hospitalized with pneumococcal pneumonia was 64 years (range, 16 to 92); 58% were male, 75% had comorbidities, 26% were admitted to the intensive care unit and 9% needed mechanical ventilation. The rate of all adverse outcomes and hospital LOS increased directly with increasing PSI, CURB-65 and SCAP scores. The three severity scores allowed us to predict the risk of in-hospital complications and 30-day mortality. The PSI score was more sensitive and the SCAP was more specifi c to predict in-hospital complications and the risk of death. However, the SCAP was more sensitive and specifi c in predicting the use of mechanical ventilation. Conclusion: The severity scores validated in the literature allow us to predict the risk of complications and death in adult patients hospitalized with pneumococcal pneumonia. Nevertheless, the clinical indexes differ in their sensitivity, specifi city and discriminatory power to predict different adverse events.Key words: Streptococcus pneumoniae, community-acquired pneumonia, severity assessment, mortality, risk classifi cation, prediction rule.Palabras clave: Streptococcus pneumoniae, neumonía adquirida en la comunidad, evaluación de la gravedad, mortalidad, clasifi cación de riesgo, regla de predicción. IntroducciónS treptococcus pneumoniae es el principal agente causal de neumonía adquirida en la comunidad (NAC) en el adulto inmunocompetente 1-3 , con una incidencia estimada de 6-10 casos por 100.000 personasaño 4,5 . La mortalidad de la neumonía neumocóccica es cercana a 5% y aumenta signifi cativamente en el adulto mayor y el hospedero inmunocomprometido. La morbimortalidad descendió signifi cativamente con la introducción de la antibioterapia 6 ; sin embargo, el riesgo de complicaciones y muerte por neumonía varía en la población 3 , dependiendo de la edad del hospedero, su estado inmune, presencia de co-morbilidades, agente etiológico, gravedad y extensión de la infección pulmonar, y grado de adherencia al tratamiento recomendado en las guías clínicas [7][8][9] .Una vez establecido el diagnóstico, las guías clínicas de neumonía 10-12 recomiendan evaluar la grav...

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A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia

Cited by 194 publications

References 22 publications

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

Índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía neumocóccica adquirida en la comunidad

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