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Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia.
MedLine Citation:
PMID:  23036136     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
SUMMARY AT A GLANCE: Australasian emergency and respiratory physicians infrequently use the Pneumonia Severity Index (PSI) and are unable to apply it accurately. Two physician groups differed in their relative abilities to apply PSI and CURB65, suggesting fragmented guideline dissemination. Australasian guidelines should promote a simple, coordinated pneumonia severity assessment tool that reaches across specialties. ABSTRACT: Background and objective:   The value of community-acquired pneumonia (CAP) severity scoring tools is almost exclusively reliant upon regular and accurate application in clinical practice. Until recently, the Australasian Therapeutic Guidelines has recommended use of the Pneumonia Severity Index (PSI), in spite of poor user-friendliness. Methods:  Electronic and postal survey of respiratory and emergency medicine physician and specialist registrar members of their Royal Australasian Colleges was undertaken to assess use of the PSI and the accuracy of its application to hypothetical clinical CAP scenarios. CURB65 score was also assessed as a simpler alternative. Results:   536 (228 respiratory, 308 emergency) responses were received. Only 12% of respiratory and 35% of emergency physicians reported using the PSI always or frequently. The majority were unable to accurately approximate PSI scores, with significantly fewer respiratory than emergency physicians recording accurate severity classes (11.8 vs. 21%, OR 0.50, 95% CI 0.37-0.68, p<0.0001). In contrast, significantly more respiratory physicians were able to accurately calculate the CURB65 score (20.4 vs. 15%, OR 1.45, 95% CI 1.10-1.91, p=0.006). Conclusions:   Australasian specialist physicians primarily responsible for the acute management of CAP report infrequent use of the PSI and are unable to accurately apply its use to hypothetical scenarios. Furthermore, respiratory and emergency physicians contrasted distinctly in their use and application of the two commonest severity scoring systems-the recent recommendation of two further alternative scoring tools by Australian guidelines may add to this confusion. A simple, coordinated approach to pneumonia severity assessment across specialties in Australasia is needed. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
Authors:
Dj Serisier; S Williams; Sd Bowler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-4
Journal Detail:
Title:  Respirology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1843     ISO Abbreviation:  Respirology     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9616368     Medline TA:  Respirology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.
Affiliation:
Dept of Respiratory Medicine, Mater Adult Hospital, South Brisbane, Qld, Australia University of Queensland, Mater Health Services, South Brisbane, Qld, Australia Mater Medical Research Institute, South Brisbane, Qld, Australia Genesis Sleepcare, RiverCity Private Hospital, Auchenflower, Qld, Australia.
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