Pneumonia severity Index.

Prediction Rule to Identify Low-Risk Patients with Community Acquired Pneumonia

Demographics

Gender Male Female Age

Nursing home resident

Comorbid Illnesses

Neoplastic disease

Liver disease

Congestive Heart Failure

Cerebrovascular disease

Renal disease

Physical exam findings

Altered Mental Status

Respiratory rate > 30/min

Systolic blood pressure < 90 mmHg

Temp < 35 or > 40 degrees C

Pulse > 125./min

Laboratory findings

pH < 7.35

BUN > 10.7 mmol/L

Sodium < 130 mEq/L

Glucose > 13.9 mmol/L

Hematocrit < 30 %

PO2 < 60 mmHg

Radiographic findings

Pleural effusion

Total Points

Risk Class

Stratification of Risk Score Risk Class Based on Mortality % Low I Algorithm 0.1 Low II 70 or < pts 0.6 Low III 71-90  pts 2.8 Moderado IV 91-130 pts 8.2 High V > 130  pts 29.2

Chest x-rays: What to look for:

Two findings are associated with mortality: bilateral pleural effusions and multilobar disease.The kappa agreement for detection of these findings is modest (.46 and .51 respectively). The relative risk of bilateral pleural effusions as a predictor of mortality was 2.8 and the odds ratio of multilobar disease as a prognostic factor for mortality was 3.1

References

Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336:243-250.
Fine MJ, Hough LJ, Medsger AR, et al. The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 1997; 157:36-44.
Fine MJ, Medsger AR, Stone RA, et al. The hospital discharge decision for patients with community-acquired pneumonia. Results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 1997; 157:47-56
Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. Jama 1996; 275:134-141.
Hasley PB, Albaum MN, Li YH, et al. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia? Arch Intern Med 1996; 156:2206-2212.
Albaum MN, Hill LC, Murphy M, et al. Interobserver reliability of the chest radiograph in community-acquired pneumonia. PORT Investigators. Chest 1996; 110:343-350.
Disclaimer:This prediction model for prognosis in patients with community-acquired pneumonia may be used to help guide the initial decision on site of care. However, its use may not be appropriate for all patients with this illness and therefore should be applied in conjunction with physician judgment. Information provided is not intended to be medical or technical advice. The information given at this site is for educational purposes only and is not sufficient for medical decisions. I disclaim any liability for the acts of any physicians or any other individual who receives any information on any medical procedure through this web site. I accept no legal responsibility for any injury and/or damage to persons or property from any of the suggestions or material discussed herein.