Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae

Kontou, Paschalina; Kuti, Joseph L.; Nicolau, David P.

doi:10.1016/j.ajem.2008.07.037

Cited by 36 publications

(19 citation statements)

References 19 publications

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“…Consequently, the results showed less heterogeneity (I 2 = 38.9%, Cochrans Q p = 0.1 for the PSI DOR; I 2 = 20.2%, Cochrans Q p = 0.3 for CURB65 DOR). For the IDSA/ATS minor criteria, removing the two studies (Kontou et al [42] and Feldman et al [41]) involving Staphylococcus pneumoniae patients only reduced but did not completely abolish the heterogeneity (I 2 = 50.7%, Cochrans Q p = 0.1 for the DOR). Analyses for CRB65 and the ATS 2001 criteria were limited due to the small number of studies and a limited number of high-quality studies, respectively.…”

Section: Assessment Of Source Studies and Sources Of Heterogeneitymentioning

confidence: 99%

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Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

et al. 2011

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Section: Assessment Of Source Studies and Sources Of Heterogeneitymentioning

confidence: 99%

“…Table 3 shows the comparison in the AUC between 30-day mortality and ICU admission in the included studies. Mortality data were not reported in some studies, while others did not provide sufficient data to determine the area under the ROC curve [12,21,27,30,[40][41][42][43].…”

Section: Prediction Of Mortalitymentioning

confidence: 99%

Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

et al. 2011

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“…Likewise, in a study from Greece including only patients with pneumococcal CAP, the 2007 IDSA/ATS criteria performed as well as the 2001 modified ATS rule in predicting ICU admission. Both demonstrated high sensitivity (90%) and NPV (97%) [20]. Table 1 summarizes the performance of the different scores.…”

Section: Scores For Severe Capmentioning

confidence: 99%

Towards a sensible comprehension of severe community-acquired pneumonia

2010

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Four different rules have been suggested and validated for intensive care unit (ICU) admission for community-acquired pneumonia: modified American Thoracic Society (ATS) rule, Infectious Diseases Society of America (IDSA)/ATS rule, España rule, and SMART-COP. Their performance varies, with sensitivity of around 70% and specificity of around 80-90%. Only negative predictive values are consistently high. Critical methodological issues include the appropriate reference for derivation, the populations studied, the variables included, and the time course of pneumonia. Severe community-acquired pneumonia (SCAP) may evolve because of acute respiratory failure or/and severe sepsis/septic shock. Pneumonia-related complications and decompensated comorbidities may be additional or independent reasons for a severe course. All variables included in predictive rules relate to the two principal reasons for SCAP. However, taken as major criteria, they are of little value for clinical assessment. Instead, a limited set of minor criteria reflecting severity seems appropriate. However, predictive rules may not meet principal needs of severity assessment because of failure in sensitivity, ignorance of the potential contribution of complications or decompensated comorbidity to pneumonia severity, and poor sensitivity for the lower extreme in the spectrum of severe pneumonia, i.e., patients at risk of SCAP. We therefore advocate an approach that refers to the evaluation of the need for intensified treatment rather than ICU, based on a set of minor criteria and sensitive to the dynamic nature of pneumonia. Intensified treatment such as monitoring and treatment of acute respiratory failure or/and severe sepsis/septic shock is thought to improve management and possibly outcomes by setting the focus on both patients with severity criteria at admission and those at risk for SCAP.

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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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Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae

Cited by 36 publications

References 19 publications

Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis

Towards a sensible comprehension of severe community-acquired pneumonia

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

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