Thorax 2000;55:219-223 ( March )

Severity prediction rules in community acquired pneumonia: a validation study

W S Lim, S Lewis, J T Macfarlane

Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK

Correspondence to: Dr J T Macfarlane

Received 24 August 1999; Returned to authors 8 November 1999; Revised version received 30 November 1999; Accepted for publication 1 December 1999

BACKGROUNDThe British Thoracic Society (BTS) developed a rule (BTSr) based on severity criteria to predict short term mortality in adults admitted to hospital with community acquired pneumonia (CAP). However, neither the BTSr nor a recent modification of it (mBTSr) have been validated in the UK. A case-control study was conducted in a typical UK population to determine the clinical factors predictive of mortality and to assess the performance of these rules.
METHODSCases were drawn from all patients with CAP who died in 1997 in five large hospitals in the Mid Trent area. Controls were randomly selected from survivors. Factors associated with mortality were identified following review of medical case notes and performance of the severity prediction rules assessed.
RESULTSAge >65 years, temperature <37°C, respiratory rate >24 breaths/min, mental confusion, urea concentration of >7 mmol/l, sodium concentration of <135 mmol/l, and the presence of a pleural effusion, all determined on admission, were independently associated with in-hospital mortality on multivariate analysis. The BTSr was 52% sensitive and 79% specific in predicting death while the mBTSr displayed 66% sensitivity and 73% specificity.
CONCLUSIONSThe value of three of the four factors (presence of mental confusion, raised respiratory rate, raised urea) used in the mBTSr as predictors of mortality is confirmed. However, the BTSr and mBTSr did not perform as well in this validation study which included a high proportion (48%) of elderly patients (75 years) compared with the derivation studies.


Keywords: community acquired pneumonia; prediction rule; severity

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© 2000 by Thorax
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