Identifying severe community‐acquired pneumonia in the emergency department: A simple clinical prediction tool

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

doi:10.1111/j.1742-6723.2007.01003.x

Cited by 59 publications

(61 citation statements)

References 16 publications

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“…However, in their study population over 56% had severe pneumonia (Pneumonia Severity Index IV or V); on the other hand, they considered oxygen saturation regardless of the F IO 2 . 20 In our cohort with mild pneumonia, hypoxemia was associated with bilateral radiological involvement, hypoalbuminemia, and COPD. Bilateral or multi-lobar alveolar infiltrates predicted the failure of the early and late pneumonia treatment, and is included in several pneumonia severity scales.…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

et al. 2011

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the Neumonía Adquirida en la Comunidad de la Comunidad Valenciana Study Group BACKGROUND: Hypoxemia may influence the prognosis of patients with mild pneumonia, regardless of the initial CURB-65 score (confusion, blood urea nitrogen > 20 mg/dL, respiratory rate > 30 breaths/min, blood pressure < 90/60 mm Hg, and age > 65 y). OBJECTIVE: To determine the risk factors associated with hypoxemia and the influence of hypoxemia on clinical outcomes in hospitalized patients with mild pneumonia. METHODS: We performed a multicenter prospective cohort study of 585 consecutive hospitalized patients with mild pneumonia (CURB-65 groups 0 and 1). We stratified the patients according to the presence of hypoxemia, defined as a P aO 2 / F IO 2 < 300 mm Hg on admission. We assessed the risk factors associated with hypoxemia, hypoxemia's influence on the course of pneumonia, and clinical outcomes (mortality, hospital stay, and need for intensive care unit admission), with multivariable regression. RESULTS: Fifty percent of the patients (294 cases) had hypoxemia on admission. The risk factors independently associated with hypoxemia were: bilateral radiological involvement (odds ratio 2.8, 95% CI 1.1-7.5), history of COPD (odds ratio 2.5, 95% CI 1.4 -4.3), and hypoalbuminemia (odds ratio 2.0, 95% CI 1.1-3.5). The hypoxemic patients had longer hospital stay, higher intensive care unit admission rate, higher rate of severe sepsis, and higher mortality than the non-hypoxemic patients. CONCLUSIONS: Hypoxemia in patients with mild pneumonia is independently associated with several adverse clinical and radiological variables, and the hypoxemic patients had worse clinical outcomes than the non-hypoxemic patients. Therefore, additional attention should be paid to the presence of hypoxemia, regardless of a low CURB-65 score.

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Section: Discussionmentioning

confidence: 99%

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

et al. 2011

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“…11 In terms of comparative prognostic value when comparing CURB-65 with CRB-65, it appears that additional urea measurement does not substantially improve the predictive value of CURB-65. [12][13][14][15]17,20,23 This, along with the simplicity of CRB-65, indicates that it is emerging as potentially the most useful severity score for CAP.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…30,31 The hospitalderived CPRs all contain some or all of confusion, tachypnoea, hypotension, and age in their scoring, and therefore have similarities to CRB-65; however, these rules differ by including other criteria (such as 13 or death. 13,23 The primary care-derived clinical prediction rule has different criteria to CRB-65 (diagnosis, age, comorbid conditions, medications, and recent hospitalisation), and the additional outcome measure of hospitalisation along with death. Although preliminary results are promising, these clinical prediction rules have yet to be validated to a great extent, and therefore their use in clinical practice is more uncertain.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…A number of other clinical prediction rules have been derived with promising initial results, including SCAP, 28 SOAR, 23 and CORB, 13 along with one clinical prediction rule derived entirely in primary care. 30,31 The hospitalderived CPRs all contain some or all of confusion, tachypnoea, hypotension, and age in their scoring, and therefore have similarities to CRB-65; however, these rules differ by including other criteria (such as 13 or death.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…8,[11][12][13][14][15][16][17][18][19][20][21][22][23] Table 1 summarises the characteristics of the included studies. Additional data were provided from three studies, 13,15,23 and clarification of included overlapping subjects obtained from two other studies. 12,16 Only one study was performed entirely in a primary care setting, 8 although two other studies did include data from patients who were treated as outpatients.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

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Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis

McNally¹,

Curtain²,

O'Brien³

et al. 2010

Br J Gen Pract

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The CRB-65 score is a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality. AimThe study sought to validate CRB-65 and assess its clinical value in community and hospital settings. Design of studySystematic review and meta-analysis of validation studies of CRB-65. Medline (1966 to June 2009), Embase (1988 to November 2008, British Nursing Index (BNI) and PsychINFO were searched, using a diagnostic accuracy search filter combined with subject-specific terms. The derived (index) rule was used as a predictive model and applied to all validation studies. Comparison was made between the observed and predicted number of deaths stratified by risk group (low, intermediate, and high) and setting of care (community or hospital). Pooled results are presented as risk ratios (RRs) in terms of over-prediction (RR>1) or under-prediction (RR<1) of 30-day mortality. Method ResultsFourteen validation studies totalling 397 875 patients are included. CRB-65 performs well in hospitalised patients, particularly in those classified as intermediate (RR 0.91, 95% confidence interval [CI] = 0.71 to 1.17) or high risk (RR 1.01, 95% CI = 0.87 to 1.16). In community settings, CRB-65 over-predicts the probability of 30-day mortality across all strata of predicted risk, low (RR 9.41, 95% CI = 1.75 to 50.66), intermediate (RR 4.84, 95% CI = 2.61 to 8.69), and high (RR 1.58, 95% CI = 0.59 to 4.19). ConclusionCRB-65 performs well in stratifying severity of pneumonia and resultant 30-day mortality in hospital settings. In community settings, CRB-65 appears to over-predict the probability of 30-day mortality across all strata of predicted risk. Caution is needed when applying CRB-65 to patients in general practice. Keywordsgeneral practice; meta-analysis; pneumonia; prognosis; severity of illness index. INTRODUCTIONCommunity-acquired pneumonia (CAP) has an annual incidence of 5-11 per 1000, accounting for 5-12% of all cases of adult lower respiratory tract infection managed by GPs.1 Appropriate management for patients with suspected CAP must be determined by GPs at initial presentation, particularly with regard to whether or not to manage a patient in the community or refer them to hospital.2 The proportion of adults with CAP who require hospital admission in the UK varies between 22% and 42%.1 This proportion varies in other countries, possibly due to differing structures of primary and secondary healthcare systems.

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Pneumonia Severity Scores and Prescribing Antibiotics for Community‐Acquired Pneumonia at an Australian Hospital

Brett¹,

Lam

Baysari

et al. 2013

Pharmacy Practice and Res

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Aim To evaluate the use of pneumonia severity scores for diagnosing community‐acquired pneumonia (CAP) and to assess whether antibiotic prescribing was compliant with guidelines as determined by the calculated pneumonia severity score. Method A retrospective chart review was undertaken of consecutive adults admitted via the emergency department with a diagnosis of CAP during a 6‐month period. Charts were reviewed for symptoms and radiographic evidence of pneumonia and for recorded pneumonia severity scores. Pneumonia severity scores were calculated using CORB, CURB‐65 and SMART‐COP for patients with available data and used to assess compliance with the Therapeutic Guidelines: Antibiotic. Results Of the 204 patients reviewed Of the 204 patients reviewed CURB‐65 and SMART‐COP scores for the remaining 68 patients, 13 (19%), 3 (4.4%) and 1 (3.6%) patients had severe pneumonia. 93% of patients received ceftriaxone. An average of 8% of patients were prescribed antibiotics compliant with the Therapeutic Guidelines: Antibiotic. Compliance varied with the pneumonia severity scoring tool used. Conclusion Pneumonia severity scores were rarely calculated to guide treatment and antibiotic prescribing for CAP. Compliance with the Therapeutic Guidelines: Antibiotic was poor and varied with the pneumonia severity scoring tool used. An easy‐to‐use pneumonia severity score to guide patient admission and choice of antibiotic is needed.

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Identifying severe community‐acquired pneumonia in the emergency department: A simple clinical prediction tool

Cited by 59 publications

References 16 publications

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis

Pneumonia Severity Scores and Prescribing Antibiotics for Community‐Acquired Pneumonia at an Australian Hospital

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