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Journal of The Korean Society of Emergency Medicine 2009;20(1): 122-129. |
| The Clinical Impact of the Pneumonia Severity Index and the CURB-65 for Making Admission Decisions |
| Jeong Ryul Jo, Young Ho Jin, Tae Oh Jeong, Jae Bak Lee |
| Department of Emergency Medicine and the Institute of Medical Science, Chonbuk National University Medical School, Jeonju, Korea. emjin@chonbuk.ac.kr |
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| ABSTRACT |
PURPOSE:
The aim of our study was to examine the discrepancies between the Pneumonia Severity Index (PSI) score, the CURB-65 [confusion, blood urea nitrogen, respiratory rate and blood pressure with age (65 years)] and the clinical judgment for making admission decisions, and we also wanted to evaluate the value of the PSI and CURB-65 as the indicators for detecting inappropriate hospitalization among the patients with low risk CAP.
METHODS:
The medical records of 286 patients who visited the emergency department with CAP were identified by their PSI and their CURB-65, and we reviewed whether there existed a clinical basis to justify their hospitalization.
RESULTS:
Of a total 286 patients, 225 patients were admitted to the hospital. Sixty five patients with a PSI of I or II, and 117 patients with a CURB-65 of 0 or 1 were admitted by clinical judgment. The factors that justified admission of a lower risk CAP group were medical conditions other than CAP (56.9% vs 70.1%; PSI vs CURB-65), failure of outpatient therapy (24.6% vs 19.6%), social needs (6.2% vs 2.6%) and hypoxemia in 1 patient (1.5% vs 0.9%, respectively). Of the patients in the low risk group according to the CURB-65, one five patient was hospitalized for suspicion of sepsis. The positive predicted values of the PSI and CURB- 65 for inappropriate hospitalization of low risk CAP patients were 10.8% and 5.9%, respectively.
CONCLUSION:
The PSI and CURB-65 had unacceptably low positive predictive values and this was due to the comorbid conditions that required in-hospital care for the patients with low risk CAP. These indices did not supersede clinical judgment for making the decision to hospitalize low risk patients with CAP. |
| Key words:
Community-Acquired Infection, Pneumonia, Severity of Illness Index |
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