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KMID : 0385920090200010122
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Journal of the Korean Society of Emergency Medicine
2009 Volume.20 No. 1 p.122 ~ p.129
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The Clinical Impact of the Pneumonia Severity Index and the CURB-65 for Making Admission Decisions
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Jo Jeong-Ryul
Lee Jae-Baek
Jung Tae-Oh
Jin Young-Ho
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Abstract
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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.
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KEYWORD
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Community-Acquired Infection, Pneumonia, Severity of Illness Index
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