Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Export

@article{citeulike:163477, abstract = {BACKGROUND: In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups. METHODS: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80\% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort. RESULTS: 1068 patients were studied (mean age 64 years, 51.5\% male, 30 day mortality 9\%). Age >/=65 years (OR 3.5, 95\% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95\% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95\% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate >/=30/min, low systolic(<90 mm Hg) or diastolic (</=60 mm Hg) Blood pressure), age >/=65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7\%; score 1, 3.2\%; score 2, 3\%; score 3, 17\%; score 4, 41.5\% and score 5, 57\%. The validation cohort confirmed a similar pattern. CONCLUSIONS: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups.}, address = {Respiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK.}, author = {Lim, W. S. and van der Eerden, M. M. and Laing, R. and Boersma, W. G. and Karalus, N. and Town, G. I. and Lewis, S. A. and Macfarlane, J. T.}, citeulike-article-id = {163477}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/12728155}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=12728155}, issn = {0040-6376}, journal = {Thorax}, keywords = {cap, id}, month = {May}, number = {5}, pages = {377--382}, posted-at = {2005-04-18 13:16:30}, priority = {2}, title = {Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/12728155}, volume = {58}, year = {2003} }

TY - JOUR ID - citeulike:163477 L3 - citeulike-article-id:163477 N2 - BACKGROUND: In the assessment of severity in community acquired pneumonia (CAP), the modified British Thoracic Society (mBTS) rule identifies patients with severe pneumonia but not patients who might be suitable for home management. A multicentre study was conducted to derive and validate a practical severity assessment model for stratifying adults hospitalised with CAP into different management groups. METHODS: Data from three prospective studies of CAP conducted in the UK, New Zealand, and the Netherlands were combined. A derivation cohort comprising 80% of the data was used to develop the model. Prognostic variables were identified using multiple logistic regression with 30 day mortality as the outcome measure. The final model was tested against the validation cohort. RESULTS: 1068 patients were studied (mean age 64 years, 51.5% male, 30 day mortality 9%). Age >/=65 years (OR 3.5, 95% CI 1.6 to 8.0) and albumin <30 g/dl (OR 4.7, 95% CI 2.5 to 8.7) were independently associated with mortality over and above the mBTS rule (OR 5.2, 95% CI 2.7 to 10). A six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate >/=30/min, low systolic(<90 mm Hg) or diastolic (</=60 mm Hg) Blood pressure), age >/=65 years (CURB-65 score) based on information available at initial hospital assessment, enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. The validation cohort confirmed a similar pattern. CONCLUSIONS: A simple six point score based on confusion, urea, respiratory rate, blood pressure, and age can be used to stratify patients with CAP into different management groups. IS - 5 JF - Thorax SN - 0040-6376 AD - Respiratory Infection Research Group, Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK. EP - 382 TI - Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. VL - 58 SP - 377 KW - cap KW - id AU - Lim, WS AU - van der Eerden, MM AU - Laing, R AU - Boersma, WG AU - Karalus, N AU - Town, GI AU - Lewis, SA AU - Macfarlane, JT PY - 2003/05// UR - http://view.ncbi.nlm.nih.gov/pubmed/12728155 ER -