Pneumonia Severity Index

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Jacob Shank, MD

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Pneumonia Severity Index

  1. 1. Pneumonia Severity Index Shank's Wee Wee Vol. 1
  2. 2. 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
  3. 3. 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
  4. 4. 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.
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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

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