Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia

Objective strategies are needed to improve the diagnosis of severe community-acquired pneumonia in the emergency department setting. To develop and validate a clinical prediction rule for identifying patients with severe community-acquired pneumonia, comparing it with other prognostic rules. Data co...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2006-12, Vol.174 (11), p.1249-1256
Main Authors: Espana, Pedro P, Capelastegui, Alberto, Gorordo, Inmaculada, Esteban, Cristobal, Oribe, Mikel, Ortega, Miguel, Bilbao, Amaia, Quintana, Jose M
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Area Under Curve
Biological and medical sciences
Blood pressure
Clinical death. Palliative care. Organ gift and preservation
Community-Acquired Infections - diagnosis
Comorbidity
Decision making
Emergency medical care
Fatalities
Female
Humans
Injuries of the nervous system and the skull. Diseases due to physical agents
Intensive care
Intensive care medicine
Male
Management decisions
Medical sciences
Middle Aged
Mortality
Multivariate Analysis
Patients
Pneumonia
Pneumonia - diagnosis
Pneumonia - epidemiology
Predictive Value of Tests
Prognosis
Sepsis
Traumas. Diseases due to physical agents
Variables
Ventilators
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Summary:Objective strategies are needed to improve the diagnosis of severe community-acquired pneumonia in the emergency department setting. To develop and validate a clinical prediction rule for identifying patients with severe community-acquired pneumonia, comparing it with other prognostic rules. Data collected from clinical information and physical examination of 1,057 patients visiting the emergency department of a hospital were used to derive a clinical prediction rule, which was then validated in two different populations: 719 patients from the same center and 1,121 patients from four other hospitals. In the multivariate analyses, eight independent predictive factors were correlated with severe community-acquired pneumonia: arterial pH < 7.30, systolic blood pressure < 90 mm Hg, respiratory rate > 30 breaths/min, altered mental status, blood urea nitrogen > 30 mg/dl, oxygen arterial pressure < 54 mm Hg or ratio of arterial oxygen tension to fraction of inspired oxygen < 250 mm Hg, age > or = 80 yr, and multilobar/bilateral lung affectation. From the beta parameter obtained in the multivariate model, a score was assigned to each predictive variable. The model shows an area under the curve of 0.92. This rule proved better at identifying patients evolving toward severe community-acquired pneumonia than either the modified American Thoracic Society rule, the British Thoracic Society's CURB-65, or the Pneumonia Severity Index. A simple score using clinical data available at the time of the emergency department visit provides a practical diagnostic decision aid, and predicts the development of severe community-acquired pneumonia.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.200602-177OC