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.
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