Community acquired pneumonia: aetiology and usefulness of severity criteria on admission.

Neill, Alister; Martin, I. R.; Weir, Robin A.P.; Anderson, Robert N.; Chereshsky, A; Epton, Michael; Jackson, Rodger; Schousboe, Mona; Frampton, Christopher; Hutton, S.; Chambers, Stephen T.; Town, G. Ian

doi:10.1136/thx.51.10.1010

Cited by 354 publications

(304 citation statements)

References 18 publications

(3 reference statements)

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…Several studies could confirm excellent operative characteristics of the original [24,25] or a slightly modified rule [26]. The sensitivities ranged from 70±90%, and the specificities from 76±84% (table 6).…”

Section: Prognostic Rules For the Individual Hospitalized Patientmentioning

confidence: 93%

Severity assessment in community-acquired pneumonia

Ewig¹,

Schäfer²,

Torres³

2000

Eur Respir J

View full text Add to dashboard Cite

In current guidelines for the management of adults with community‐acquired pneumonia (CAP), the triaging decision about hospitalization or intensive care unit (ICU) admission, and, as a consequence, selection of initial antimicrobial treatment is largely based on the assessment of pneumonia severity. The proposed severity criteria are mainly derived from studies determining pre‐dictors of adverse outcome. These include age, male sex, comorbidity, acute respira‐tory failure, severe sepsis and septic shock, extension of radiographic infiltrates, bacteraemia and CAP through several different pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, Gram‐negative enteric bacilli (GNEB), and signs of disease progression within the first 48–72 h. In addition, prediction rules and need for a complicated course in ambulatory and hospitalized patients, for the individual risk of death have been developed which may be helpful in determining the patient who might require hospitalization or intensive care, respectively. Risk classifications such as the scores developed by F ineet al. [40] are not only useful for identifying low risk patients who might safely be treated as outpatients, but apparently they will also play a major role in the evaluation of processes and outcomes of care for patients with CAP. Recent investigations have provided objective criteria for the definition of severe CAP requiring ICU admission. Whether the detection of infiltrates in the chest radiographs of patients with acute lower respiratory tract infection (LRTI) suggestive of mild pneumonia has an independent prognostic impact which fundamentally affects the concept of mild LRTI remains to be seen. Based on objective criteria for severity assessment it will be possible to define interventions aimed at reducing hospital admission rates, define a risk‐adapted anti‐microbial treatment regimen, reduce costs for antimicrobial treatment and supportive measures, shorten hospital stay, and, thereby, improve the quality of care for patients with community‐acquired pneumonia.

show abstract

Section: Prognostic Rules For the Individual Hospitalized Patientmentioning

confidence: 93%

Severity assessment in community-acquired pneumonia

Ewig¹,

Schäfer²,

Torres³

2000

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…4 8 This prediction tool has been independently validated and widely endorsed. 2 3 9-11 N The CURB index 6 was derived from the original BTS study 12 and uses four core clinical features: confusion of new onset (or worsening of existing state for those with background cognitive impairment), serum urea .7 mmol/ l, respiratory rate >30/min, and blood pressure (systolic blood pressure ,90 mm Hg or diastolic blood pressure (60 mm Hg). The presence of two or more of these four criteria led to a ''severe'' classification.…”

Section: Methodsmentioning

confidence: 99%

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

Buising

Thursky²,

Black³

et al. 2006

Thorax

195

114

View full text Add to dashboard Cite

“…Three validation studies of the BTS rules, in different settings, confirmed the potential of these rules in identifying patients at risk of death caused by pneumonia [6±8]. However, these rules were derived in general populations, and the BTS derivation study [4] as well as some of the validation studies of the BTS rules [7,8] excluded part of the elderly population. Therefore, there remained concerns about the validity of these rules in community-acquired pneumonia in the elderly [9].…”

mentioning

confidence: 99%

Clinical significance of MCP-1 levels in BALF and serum in patients with interstitial lung diseases

Suga¹,

Iyonaga²,

Ichiyasu³

et al. 1999

European Respiratory Journal

View full text Add to dashboard Cite

The aim of the study was to validate the prediction rule of M.J. Fine and coworkers for clinical outcome variables and three prognostic rules for the individual outcome of community-acquired pneumonia in an elderly population (rule 1: respiratory frequency $30 breaths . min -1 , diastolic blood pressure #60 mmHg, blood urea nitrogen >7 mM; rule 2: respiratory frequency $30 breaths . min -1 , diastolic blood pressure #60 mmHg, mental confusion; and rule 3: systolic blood pressure #80 mmHg, cardiac frequency $90 beats . min -1 , lactate dehydrogenase activity $260 IU . L -1 ; death was predicted in the presence of at least two of three parameters). Overall 168 consecutive episodes of community-acquired pneumonia in patients aged $65 yrs and hospitalized in a primary care hospital were studied prospectively.Fine's rule was tested for its ability to predict length of hospital stay, requirement for intensive care unit (ICU) admission and death. For the three prognostic rules of individual outcome, performance regarding predicting death was determined.Mortality was 17/168 (10%). Fine's rule accurately predicted length of stay, the requirement for ICU admission and the risk of death from pneumonia as compared to the original derivation and validation cohorts. All three rules achieved moderate-tohigh specificity (73%, 88% and 80%, respectively) and high negative predictive values (95%, 94% and 93%, respectively) but had a low sensitivity (65%, 47% and 47%, respectively). Rule 2 most closely reflected the risk of death from pneumonia when Fine's classification was used as reference.Fine's rule proved to give valid estimations regarding clinical outcome variables of community-acquired pneumonia in the elderly. The prognostic rules may be useful in determining individual patients at lower risk of death caused by pneumonia.

show abstract

Community acquired pneumonia: aetiology and usefulness of severity criteria on admission.

Cited by 354 publications

References 18 publications

Severity assessment in community-acquired pneumonia

Severity assessment in community-acquired pneumonia

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

Clinical significance of MCP-1 levels in BALF and serum in patients with interstitial lung diseases

Contact Info

Product

Resources

About