Document Detail

Development and validation of a clinical prediction rule for severe community-acquired pneumonia.
MedLine Citation:
PMID:  16973986     Owner:  NLM     Status:  MEDLINE    
RATIONALE: Objective strategies are needed to improve the diagnosis of severe community-acquired pneumonia in the emergency department setting. OBJECTIVES: To develop and validate a clinical prediction rule for identifying patients with severe community-acquired pneumonia, comparing it with other prognostic rules. METHODS: 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. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.
Pedro P España; Alberto Capelastegui; Inmaculada Gorordo; Cristobal Esteban; Mikel Oribe; Miguel Ortega; Amaia Bilbao; José M Quintana
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Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2006-09-14
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  174     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-11-19     Completed Date:  2007-01-10     Revised Date:  2007-08-08    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1249-56     Citation Subset:  AIM; IM    
Service of Pneumology, Department of Emergency Medicine, Research Unit, Hospital de Galdakao, Galdako, Bizkaia, Spain.
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MeSH Terms
Aged, 80 and over
Area Under Curve
Community-Acquired Infections / diagnosis
Middle Aged
Multivariate Analysis
Pneumonia / diagnosis*,  epidemiology
Predictive Value of Tests
Comment In:
Am J Respir Crit Care Med. 2007 Apr 1;175(7):743; author reply 743-4   [PMID:  17384328 ]
Am J Respir Crit Care Med. 2007 Feb 1;175(3):289; author reply 289-90   [PMID:  17234911 ]
Am J Respir Crit Care Med. 2006 Dec 1;174(11):1169-70   [PMID:  17110652 ]
J Fam Pract. 2007 Feb;56(2):92   [PMID:  17607822 ]

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