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Prospective comparison of three predictive rules for assessing severity of community acquired pneumonia in Hong Kong
  1. Shin Yan Man (mansy{at}netvigator.com)
  1. Chinese University of Hong Kong, Hong Kong
    1. Nelson Lee
    1. Chinese University of Hong Kong, Hong Kong
      1. Margret Ip
      1. Chinese University of Hong Kong, Hong Kong
        1. Gregory E Antonio
        1. Chinese University of Hong Kong, Hong Kong
          1. Shirley SL Chau
          1. Chinese University of Hong Kong, Hong Kong
            1. Paulina Mak
            1. Chinese University of Hong Kong, Hong Kong
              1. Colin A Graham
              1. Chinese University of Hong Kong, Hong Kong
                1. Mingdong Zhang
                1. Chinese University of Hong Kong, Hong Kong
                  1. Grace Lui
                  1. Chinese University of Hong Kong, Hong Kong
                    1. Paul KS Chan
                    1. Chinese University of Hong Kong, Hong Kong
                      1. Anil T Ahuja
                      1. Chinese University of Hong Kong, Hong Kong
                        1. David S Hui
                        1. Chinese University of Hong Kong, Hong Kong
                          1. Joseph JY Sung
                          1. Chinese University of Hong Kong, Hong Kong
                            1. Timothy H Rainer (thrainer{at}cuhk.edu.hk)
                            1. Chinese University of Hong Kong, Hong Kong

                              Abstract

                              Introduction: Community-acquired pneumonia (CAP) is a leading infectious diseases cause of death throughout the world, including Hong Kong. The aim of this study was to compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB-65 scale adopted by the British Thoracic Society and the simpler CRB-65.

                              Methods: Prospective observational study of consecutive 1016 CAP in-patients [583 men (57.4%), mean age 72 ± 17 years] in a university hospital in Hong Kong's New Territories in 2004. Patients were classified into 3 risk groups (low, intermediate and high) according to each rule. We compared their ability to predict 30 day-mortality.

                              Results: The overall mortality and intensive care unit (ICU) admission rates were 8.6% and 4.0% respectively. PSI, CURB-65 and CRB-65 performed similarly and the areas under the ROC curve (95% confidence intervals) were 0.736 (0.687-0.736), 0.733(0.679-0.787) and 0.694 (0.634-0.753) respectively. All three rules had high negative predictive values but relatively low positive predictive values at all cut-off points. Larger proportions of patients were identified as low risk by PSI (47.2%) and CURB-65 (43.3%), in contrast to CRB-65 (12.6%).

                              Conclusion: All three predictive rules have a similar performance in CAP severity prediction but CURB-65 is more suitable than the other two rules for use in the emergency department given its simplicity of application and ability to identify low risk patients.

                              • community acquired pneumonia
                              • comparison
                              • mortality
                              • predictive rules
                              • risk stratification

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