Validation of Scoring Systems for Predicting Severe Community-Acquired Pneumonia

Fukuyama, Hajime; Ishida, Tadashi; Takahashi, Hiromasa; Nakagawa, Hiroaki; Iwasaku, Masahiro; Saigusa, M; Yoshioka, Hiroshige; Arita, Machiko; Hashimoto, Toru

doi:10.2169/internalmedicine.50.5279

Cited by 17 publications

(19 citation statements)

References 21 publications

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“…Significant heterogeneity was present. Performance of PSI to predict an alternative definition of SCAP, including mortality, was superior, with a pooled sensitivity of 92.4% (CI, 89 to 95) and specificity of 56.2% (CI, 43 to 69) in four cohorts including 3,195 patients [11,49]. …”

Section: Resultsmentioning

confidence: 99%

“…CURB-65 was studied in nine cohorts [21,24,25,27,40,42,47,49,50] including a total of 5,773 patients and 479 ICU admissions (8.3%). At the usual cut-off value of 3 or more, pooled sensitivity was 56%, and specificity, 74%.…”

Section: Resultsmentioning

confidence: 99%

“…We identified eight studies [5,22,24,32,33,39,40,45,49] including a total number of 7,116 patients with 908 ICU admissions (12.8%). The pooled sensitivity was 69.5%, and specificity, 90.1%.…”

Section: Resultsmentioning

confidence: 99%

“…The rule is considered positive in the presence of one major or three minor criteria. We found five publications evaluating this rule [23,39,42,49,50]. Two studies, including 2,400 patients and 266 ICU patients (11%), validated the original rule to predict ICU admission [39,49].…”

Section: Resultsmentioning

confidence: 99%

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Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis

et al. 2012

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IntroductionSeverity assessment and site-of-care decisions for patients with community-acquired pneumonia (CAP) are pivotal for patients' safety and adequate allocation of resources. Late admission to the intensive care unit (ICU) has been associated with increased mortality in CAP. We aimed to review and meta-analyze systematically the performance of clinical prediction rules to identify CAP patients requiring ICU admission or intensive treatment.MethodsWe systematically searched Medline, Embase, and the Cochrane Controlled Trials registry for clinical trials evaluating the performance of prognostic rules to predict the need for ICU admission, intensive treatment, or the occurrence of early mortality in patients with CAP.ResultsSufficient data were available to perform a meta-analysis on eight scores: PSI, CURB-65, CRB-65, CURB, ATS 2001, ATS/IDSA 2007, SCAP score, and SMART-COP. The estimated AUC of PSI and CURB-65 scores to predict ICU admission was 0.69. Among scores proposed for prediction of ICU admission, ATS-2001 and ATS/IDSA 2007 scores had better operative characteristics, with a sensitivity of 70% (CI, 61 to 77) and 84% (48 to 97) and a specificity of 90% (CI, 82 to 95) and 78% (46 to 93), but their clinical utility is limited by the use of major criteria.ATS/IDSA 2007 minor criteria have good specificity (91% CI, 84 to 95) and moderate sensitivity (57% CI, 46 to 68). SMART-COP and SCAP score have good sensitivity (79% CI, 69 to 97, and 94% CI, 88 to 97) and moderate specificity (64% CI, 30 to 66, and 46% CI, 27 to 66). Major differences in populations, prognostic factor measurement, and outcome definition limit comparison. Our analysis also highlights a high degree of heterogeneity among the studies.ConclusionsNew severity scores for predicting the need for ICU or intensive treatment in patients with CAP, such as ATS/IDSA 2007 minor criteria, SCAP score, and SMART-COP, have better discriminative performances compared with PSI and CURB-65. High negative predictive value is the most consistent finding among the different prediction rules. These rules should be considered an aid to clinical judgment to guide ICU admission in CAP patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis

et al. 2012

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“…The IDSA/ATS criteria have now been validated for prediction of 30-day mortality, ICU admission and requirement for subsequent mechanical ventilation or vasopressor (MV/VS) use in several countries [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Salih

Schembri

Chalmers

2013

European Respiratory Journal

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The 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines proposed ''minor'' criteria to predict intensive care unit (ICU) admission in patients with community-acquired pneumonia. These criteria were based on expert opinion. Consequently, the authors of the guidelines asked investigators to determine whether the score could be simplified by excluding noncontributory variables.Each IDSA/ATS minor criterion was validated using a random effects meta-analysis of seven studies. Variables present in ,5% of cases or that were nonsignificantly associated with mortality/ICU admission were excluded. A simplified score excluding these variables was tested for prediction of mortality and ICU admission in an established database. Prediction was assessed using the area under the receiver operator characteristic curve (AUC).Leukopenia (,4000 cells?mm -3 ), thrombocytopenia (,100 000 cells?mm -3 ) and hypothermia ,36uC occurred in ,5% of cases. A simplified score excluding these variables was performed similarly for prediction of mortality, AUC 0.77 (95% CI 0.73-0.81) versus 0.78 (95% CI 0.74-0.82) (p50.9) and intensive care unit admission, AUC 0.85 (95% CI 0.82-0.87) versus 0.85 (95% CI 0.82-0.88) (p50.9). Additional predictors suggested by the IDSA/ATS were associated with mortality and ICU admission, but only incorporating acidosis (pH ,7.35) altered the AUC (0.82 (95% CI 0.78-0.86) (p50.6) for mortality and 0.86 (95% CI 0.82-0.88) (p50.8) for ICU admission). No improvements were statistically significant.The IDSA/ATS criteria can be simplified by removing three infrequent variables. @ERSpublicationsThe IDSA/ATS criteria can be simplified by removing three infrequent variables

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Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Fee¹,

Maughan²,

Perkins³

et al. 2021

Annals of Emergency Medicine

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Validation of Scoring Systems for Predicting Severe Community-Acquired Pneumonia

Cited by 17 publications

References 21 publications

Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis

Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis

Simplification of the IDSA/ATS criteria for severe CAP using meta-analysis and observational data

Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

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