Pneumonia Severity Index

Shank's Wee Wee Vol. 1

MedisGroup Cohort Study

• 1989 cohort of 38000 pts. • Developed PSI based on

o History

o Physical Exam

o Lab0ratory Data

• Five Classifications as a risk stratification tool

• Inappropriately used as decision tool for disposition.1

Patient Outcomes Research Team (PORT)

• Research team with multiple publications, and validation studies up to 1996 building from original cohort study.2

• Prediction Rule article in NEJM 1996 • http://www.nejm.org/doi/full/10.1056/N

EJM199701233360402#t=article. • Exclusion based on HIV and recent

hospitalization3

Two Step Scale

• Step 1 defines class I (very low risk group)

o Age<50, HR<125, SBP>90, RR<30, 35<Temp<40 and No: Heart, Liver, Renal disease or Cancer.

• Stage 2 delineates all others into classes II-V based on Labs.

• Mortality in class II (0.6-0.9%) in class III (up to 2.8%)

• Class IV and V- Strongly think about inpatient.

CURB-65 and Others

• CURB-65: British Thoracic Society • CRB-65: for people who don't like labs • IDSA/ATS 2007 consensus guidelines • SCAP score and SMART-COP: for

deciding ICU admission4

And the List Goes On

Comparisons

• 2010 Meta-analysis demonstrates PSI/PORT to be more sensitive than CURB-65, CURB is more specific

• Negative predictive value of all 4 scores studied correlated well for low risk pts.5

• Second Meta-analysis in 2010 found no difference in prediction of mortality.6

Summary

• Use your decision tools and use them correctly!

• Step 1 of PORT decision tool finds low risk patients: Age, Vitals, History.

• Use the classifications in discussions with your consults/colleagues.

• Access all the tools at MDcalc.com

References

1. Loeb, M. Evidence Based Infectious Diseases. West Sussex, UK. Blackwell Publishing. 2004 2. "Pneumonia: New Prediction Model Proves Promising". AHCPR Publication No. 97-R031. 1997 3. Fine, M. et al. "A Prediction Rule to Identify Low-Risk Patients With Community-Acquire

Pneumonia". NEJM. 1997. 336:243-250

4. Marti, Christopher. et al. "Prediction of severe community-acquired pneumonia: a systematic review

and meta-analysis". Critical Care 2012, 16:R141.

5.Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from

community-acquired pneumonia: systematic review and meta-analysis. Thorax. 2010;65:884-90

6.Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010;65:878-83