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
- predictive rules
- risk stratification
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.