What’s New in the Patient Safety World
October 2009
A
Better Tool for Predicting ICU Need in Community-Acquired Pneumonia?
Most of you are familiar with the variety of calculators and tools that have been used in the evaluation and management of patient with community-acquired pneumonia (CAP). The Pneumonia Severity Index (PSI) and the CRB-65/CURB-65 tools have been useful in predicting outcomes and helping physicians make decisions about the most appropriate level of care in which to manage the patient (outpatient, inpatient, ICU).
The American Thoracic Society developed its own prediction model in 2001 and this was updated in 2007 by the Infectious Diseases Society of American and the American Thoracic Society. These tools were developed to help predict ICU admission in patients with CAP. A new study (Kontou et al. 2009) demonstrates their usefulness in predicting ICU admission with high sensitivity and a high negative predictive value in patients with CAP caused by Streptococcus pneumoniae. Mortality was still best predicted by the PSI score. The 2007 IDSA/ATS tool was not better than the older one in predicting ICU admission and the older one is slightly simpler so expect the latter to be adopted as a tool to predict ICU admission.
References:
Fine MJ, Auble TE,
Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to
identify low-risk
patients with
community-acquired pneumonia. N Engl J Med. 1997; 336: 243-250
http://content.nejm.org/cgi/content/full/336/4/243
British Thoracic
Society Pneumonia Guidelines Committee. BTS guidelines for the management of
community-acquired
pneumonia in adults – 2004 update.
Niederman MS,
Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. American
Thoracic
Society. Guidelines
for the management of adults with community-acquired pneumonia. Diagnosis,
assessment
of severity,
antimicrobial therapy, and prevention. Am J Respir Crit Care Med.
2001;163:1730-1754
http://ajrccm.atsjournals.org/cgi/content/full/163/7/1730
Kontou P, Kuti JL,
Nicolau DP. Validation of the Infectious Diseases Society of America/American Thoracic
Society criteria to predict severe community-acquired pneumonia caused by
Streptococcus pneumoniae. American Journal of Emergency Medicine 2009; 27(8):
968-974
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