Severity assessment in community-acquired pneumonia: moving on

Severity assessment is recognised as a pivotal step in the management of community-acquired pneumonia (CAP). Consequently, much effort over the last three decades has gone into developing tools to aid this process. The Pneumonia Severity Index (PSI) was introduced in 1997 following a study in over 50 000 patients and is well established as a robust severity assessment tool in patients with CAP.¹ The CURB65 and CRB65 scores—which take account of the presence of Confusion, raised Urea (in the case of CURB65), raised Respiratory rate, low Blood pressure and age >65 years—were introduced more recently in 2003.² One of the main benefits of the CURB65 and CRB65 scores is their simplicity in comparison with the PSI which comprises 20 variables. A number of studies over the last 2 years have therefore sought to confirm the value of these scores in different healthcare settings.

In this issue of Thorax, Man et al³ report a large and well conducted validation study of these three severity assessment tools—the PSI, CURB65 and CRB65 scores (see page 348). They recruited 1016 adults with CAP seen in the emergency department of a teaching hospital in Hong Kong and found that all three severity assessment tools performed equally well at discriminating patients into mortality risk groups. The area under the receiver operating characteristic curve (AUC) …