The pneumonia severity index PSI or PORT Score is a clinical prediction rule that medical practitioners can use to calculate the probability of morbidity and mortality among patients with community acquired pneumonia. This prediction rule may help physicians make more rational decisions about hospitalization for patients with pneumonia. Mortality prediction is similar to that when using CURB The rule uses demographics whether someone is older, and is male or female , the coexistence of co-morbid illnesses, findings on physical examination and vital signs , and essential laboratory findings. This study demonstrated that patients could be stratified into five risk categories, Risk Classes I-V, and that these classes could be used to predict day survival. The purpose of the PSI is to classify the severity of a patient's pneumonia to determine the amount of resources to be allocated for care.
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Community-acquired pneumonia CAP is a common disease, representing the most frequent cause of hospital admission and mortality of infectious origin in developed countries; it also has an important impact on health expenses.
It is estimated that in Spain between 1. CAP will continue to represent an important threat to patients as the number of patients at risk people with comorbid conditions and elderly ones increases 2. The site-of-care home or hospital greatly determines the extensiveness of the diagnostic evaluation, the route of antimicrobial therapy and the economical cost.
But the site-of-care decision is also medically important 3,4 as hospitalization and admission to the intensive care unit ICU increases the risk of thromboembolic events and superinfection by more virulent or resistant hospital bacteria.
Patients at low risk for death treated in the outpatient setting are able to resume normal activity sooner and many of them also prefer outpatient therapy 2. The decision to admit a patient with CAP in medical wards or ICU may depend on subjective clinical views and peculiarities of the local healthcare setting and different studies have demonstrated that the establishment of valid criteria for a definition of severe pneumonia would provide a more reliable basis for improving patient risk assessment and therefore help physicians in their daily practice 2,5,6.
The PSI stratifies patients on the basis of 20 variables to which points are assigned into low and higher risk of short-term mortality and links this quantification of illness severity to an appropriate level of outpatient treatment Fine I and II , brief inpatient observation Fine III or more traditional inpatient therapy Fine IV and V.
Although the PSI was initially developed as a prediction rule to identify patients who were at low risk for mortality, different studies have shown that its implementation in the Emergency Departments increased the outpatient treatment rates of patients at low risk without compromising their safety. However, this score considers too many variables. Simpler criteria are needed to evaluate the risk of mortality in patients with CAP.
Our aim was to identify at first evaluation patients at increased risk of complicated evolution but considering a minimum of variables. The Hospital Universitario Virgen de la Arrixaca in Murcia Spain is a university teaching hospital comprising beds, of them belonging to the General Hospital. It takes care of a population of approximately , individuals. In our institution, the Emergency Department does not use the PSI for guiding the site-of treatment decision.
Observational- retrospective study of clinical records of patients with CAP admitted to our hospital from January to December A cohort of patients older than 12 years with CAP were included. A sample of was randomly selected for data collection from clinical records according to a standard protocol study of CAP. Medical-records numbers were used for randomisation.
We analysed epidemiological, clinical, radiological and laboratory data associated with mortality. A subanalysis of patients by age group cut-off: 65 year-old was done. This cut-off point was considered according to previous studies CURB score 8. CAP was defined as the presence of a new infiltrate on the chest X-ray along with appropriate clinical history and physical signs of lower respiratory tract infection in a patient not hospitalised within the previous month and in whom no alternative diagnosis emerged during follow-up.
Clinical, laboratory and radiological features at presentation as well as other epidemiological data were entered in a computer database. Altered mental status was defined as disorientation to person, place or time. Pleural puncture, transthoracic needle puncture, tracheobronchial aspiration in mechanically ventilated patients and protected specimen brush PSB or bronchoalveolar lavage BAL sampling were performed according to clinical indication or judgement of the attending physician.
The etiology of pneumonia was considered definitive if one of the following criteria was met: a blood cultures yielding a bacterial pathogen in the absence of an apparent extrapulmonary focus ; b pleural fluid or transthoracic needle aspiration cultures yielding a bacterial pathogen; c seroconversion i.
Patient's clinical records were assessed until in-hospital death or discharge. Mean hospitalization stay was calculated excluding patients who died to avoid artificial low stays in more severe patients. Means of continuous variables were compared by using two-tailed Student's unpaired t-test and analysis of the variance ANOVA. Multivariate analysis was performed by using a forward step-wise conditional logistic regression procedure considering all variables included in PORT-score as independent variables and mortality as the dependent variable.
Mean age was 63 years range, 13 to years , being 75 years in One or two coexisting conditions were present in Mean hospitalization stay was 7. Epidemiological, clinical, radiological and laboratory data and outcome of high-risk hospitalised patients were compared in. The initial management decision of patients with CAP is to determine the site of care outpatients or hospitalization in a medical ward or ICU and this depends on the severity of the disease.
This site-of-care decision is medically and economically important and almost all of the major decisions regarding management of CAP, including diagnostic and treatment issues 9 , revolve around the initial assessment of severity 1. Therefore, different investigators have attempted to find objective site-of-care criteria 7,10, There is a need for simpler prognostic models to guide the site-of-care decision to ensure that as many patients as possible are treated on an ambulatory basis and to identify those at high risk of mortality.
Severe CAP is a life-threatening condition and identification of patients likely to have a major adverse outcome is a key step in reducing the mortality rate of CAP The purpose of our study was to describe the population of patients with CAP admitted at a hospital where the Emergency Department does not use the PSI for guiding the site-of treatment decision.
Several results deserve further comments. First of all, a remarkable finding is that mortality rate and mean hospitalization stay were significantly higher in high risk groups table 1.
These results validate the PSI as a prediction rule that accurately identifies in our series CAP patients with low or high severity and mortality risk. Although the PSI scoring system is a reliable tool for the prediction of severity it is tedious to calculate because it considers 20 different variables. Presence of these clinical or laboratory abnormalities should be considered as mortality predictors and can be used as a severity adjustment measure and therefore may help physicians make more rational decisions about hospitalization for patients with CAP.
In our study, pH 18 , a depressed pH is likely a side effect of metabolic acidosis derived from sepsis, as probably is confusion However, our study has two limitations: considering 20 variables in the regression analysis of a cases sample and the fact that it is a retrospective analysis. A prospective validation is required to assess the generalization of these findings. However, mortality was 0.
In our opinion, age might be a consideration to be taken into account when deciding where to treat the patient because this group of patients might require respiratory and severe sepsis support Although complicated algorithms including multiple variables might be superior and have higher predictive indices, there are other important factors in the assessment of objective admission criteria In our opinion, the crucial question might be what a scoring system means for the practitioner who treats patients in the real world Emergency Departments.
An algorithm that relies on the availability of scoring sheets limits its practicality in the usual very busy emergency rooms. Early identification of the sickest patients or those with higher risk of complications may allow for earlier intervention, hence potentially improve outcomes We think that it might be more practical to implement easily memorable criteria and dealing with 5 variables instead of 20 offers greater simplicity and applicability.
Greater experience and randomized trials of alternative admission and severity criteria are required. ISSN: Simple criteria to assess mortality in patients with community-acquired pneumonia.
Descargar PDF. Hospital Universitario Virgen de la Arrixaca. El Palmar. Mean hospitalization stays by PORT-groups.. TABLE 3. Demographic and clinical characteristics of patients in high-risk PSI groups by age. Resultados: Evaluamos a una cohorte de pacientes. Palabras clave:. Simpler criteria are needed to evaluate risk of mortality in CAP. Patients and methods: Observational study of patients with CAP admitted to a tertiary care university hospital.
Epidemiological, clinical, radiological and laboratory data associated with mortality were analysed. Results: A cohort of patients with CAP was studied. Severity distribution according to PORT score was Conclusions: Simpler criteria to assess mortality in CAP were identified. These clinical or laboratory findings should be considered as mortality predictors, can be used as severity adjustment measure and may help physicians make more rational decisions about hospitalization in CAP..
Texto completo. The decision to admit a patient with CAP in medical wards or ICU may depend on subjective clinical views and peculiarities of the local healthcare setting and different studies have demonstrated that the establishment of valid criteria for a definition of severe pneumonia would provide a more reliable basis for improving patient risk assessment and therefore help physicians in their daily practice 2,5,6 The Pneumonia Patient Outcomes Research Team PORT 7 developed a prediction rule to identify patients with CAP who are at risk for death and other adverse outcomes Pneumonia Severity Index [PSI].
Patients and methods The Hospital Universitario Virgen de la Arrixaca in Murcia Spain is a university teaching hospital comprising beds, of them belonging to the General Hospital.
Study period and patients Observational- retrospective study of clinical records of patients with CAP admitted to our hospital from January to December Clin Infect Dis. Clin Infec Dis. Arch Intern Med. Ann Intern Med. Eur Respir J. Infect Dis Clin North Am. N Engl J Med.
Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Respir Med. Norasept II Study Investigators. J Crit Care. Am J Med. Use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria.
Factores relacionados con la mortalidad durante el episodio y tras el alta hospitalaria. Med Clin Barc. Outcome prediction using the Mortality in Emergency Are you a health professional able to prescribe or dispense drugs? Si continua navegando, consideramos que acepta su uso. To improve our services and products, we use "cookies" own or third parties authorized to show advertising related to client preferences through the analyses of navigation customer behavior.
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Pneumonia severity index
A pneumonia adquirida na comunidade PAC constitui a principal causa de morte no mundo. Community-acquired pneumonia CAP is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia SBPT, Brazilian Thoracic Association were published , there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy and its duration and prevention through vaccination.
Pneumonia Severity Index (PORT Score)
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Community-acquired pneumonia CAP is a common disease, representing the most frequent cause of hospital admission and mortality of infectious origin in developed countries; it also has an important impact on health expenses. It is estimated that in Spain between 1. CAP will continue to represent an important threat to patients as the number of patients at risk people with comorbid conditions and elderly ones increases 2. The site-of-care home or hospital greatly determines the extensiveness of the diagnostic evaluation, the route of antimicrobial therapy and the economical cost. But the site-of-care decision is also medically important 3,4 as hospitalization and admission to the intensive care unit ICU increases the risk of thromboembolic events and superinfection by more virulent or resistant hospital bacteria. Patients at low risk for death treated in the outpatient setting are able to resume normal activity sooner and many of them also prefer outpatient therapy 2.