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Previous Volume 336:243-250 January 23, 1997 Number 4 Next

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ABSTRACT

Background There is considerable variability in rates of hospitalization of patients with community-acquired pneumonia, in part because of physicians' uncertainty in assessing the severity of illness at presentation.

Methods From our analysis of data on 14,199 adult inpatients with community-acquired pneumonia, we derived a prediction rule that stratifies patients into five classes with respect to the risk of death within 30 days. The rule was validated with 1991 data on 38,039 inpatients and with data on 2287 inpatients and outpatients in the Pneumonia Patient Outcomes Research Team (PORT) cohort study. The prediction rule assigns points based on age and the presence of coexisting disease, abnormal physical findings (such as a respiratory rate of >30 per minute or a temperature of >40°C), and abnormal laboratory findings (such as a pH <7.35, a blood urea nitrogen concentration >30 mg per deciliter [11 mmol per liter] or a sodium concentration <130 mmol per liter) at presentation.

Results There were no significant differences in mortality in each of the five risk classes among the three cohorts. Mortality ranged from 0.1 to 0.4 percent for class I patients (P = 0.22), from 0.6 to 0.7 percent for class II (P = 0.67), and from 0.9 to 2.8 percent for class III (P = 0.12). Among the 1575 patients in the three lowest risk classes in the Pneumonia PORT cohort, there were only seven deaths, of which only four were pneumonia-related. The risk class was significantly associated with the risk of subsequent hospitalization among those treated as outpatients and with the use of intensive care and the number of days in the hospital among inpatients.

Conclusions The prediction rule we describe accurately identifies the patients with community-acquired pneumonia who are at low risk for death and other adverse outcomes. This prediction rule may help physicians make more rational decisions about hospitalization for patients with pneumonia.

Source Information

From the Division of General Medicine, Department of Medicine (M.J.F., B.H.H., W.N.K.), the Department of Emergency Medicine (T.E.A., D.M.Y.), and the Department of Biostatistics (L.A.W.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh; the General Internal Medicine Unit, Medical Services, Massachusetts General Hospital and Harvard Medical School, Boston (D.E.S., C.M.C.); and the Division of Infectious Diseases, Department of Medicine, Victoria General Hospital and Dalhousie University, Halifax, N.S., Canada (T.J.M.).

Address reprint requests to Dr. Fine at Montefiore University Hospital, 8 East Rm. 824, 200 Lothrop St., Pittsburgh, PA 15213.

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A Prediction Rule for Community-Acquired Pneumonia
Bloom S. L., Ramin S., Cunningham F. G., Tsiodras S., Malhotra G., Fine M. J., Auble T. E., Hanusa B. H., Singer D. E.
Extract | Full Text  
N Engl J Med 1997; 336:1913-1915, Jun 26, 1997. Correspondence

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