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Clinical factors predict severe CAP in adults |
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Clinical Question: Can clinical data collected at the time of diagnosis of pneumonia predict patients who will develop severe disease? Bottom Line: A simple score using clinical data available at the time of the emergency department visit provides a practical diagnostic decision aid, and predicts the development of severe community-acquired pneumonia. Reference: Espana PP, Capelastegui A, Gorordo I, et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 2006;174:1249-1256. Study Design: Decision rule (validation) Synopsis: In this study, the authors evaluated 1776 consecutive patients diagnosed with community-acquired pneumonia in a single emergency department to develop a clinical prediction rule that will identify patients who will develop severe disease (septic shock, severe sepsis, or disease requiring mechanical ventilation). In the multivariate analyses, eight independent predictive factors were correlated with severe community-acquired pneumonia: arterial pH < 7.30, systolic blood pressure < 90 mm Hg, respiratory rate > 30 breaths/min, altered mental status, blood urea nitrogen > 30 mg/dl, oxygen arterial pressure < 54 mm Hg or ratio of arterial oxygen tension to fraction of inspired oxygen < 250 mm Hg, age > or = 80 yr, and multilobar/bilateral lung affectation. From the beta parameter obtained in the multivariate model, a score was assigned to each predictive variable. The model shows an area under the curve of 0.92. This rule proved better at identifying patients evolving toward severe community-acquired pneumonia than either the modified American Thoracic Society rule, the British Thoracic Society's CURB-65, or the Pneumonia Severity Index. |
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