Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study
| Autor: | Wim Boersma, M M van der Eerden, J T Macfarlane, Sarah Lewis, Richard Laing, G. I. Town, Noel Karalus, Wei Shen Lim |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2003 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Prognostic variable business.industry Pneumonia severity index musculoskeletal neural and ocular physiology Respiratory Infection macromolecular substances medicine.disease Logistic regression CURB-65 Surgery Community-acquired pneumonia nervous system Internal medicine Severity of illness Medicine business Prospective cohort study Cohort study |
| Popis: | 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 C onfusion, U rea >7 mmol/l, R espiratory rate ⩾30/min, low systolic( B lood 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. |
| Databáze: | OpenAIRE |
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