Development and validation of a clinical prediction rule for severe community-acquired pneumonia

被引:230
作者
Espana, Pedro P. [1 ]
Capelastegui, Alberto
Gorordo, Inmaculada
Esteban, Cristobal
Oribe, Mike
Ortega, Miguel
Bilbao, Amaia
Quintana, Jose M.
机构
[1] Hosp Galdakao, Serv Pneumol, Dept Emergency Med, Galdakao 48960, Bizkaia, Spain
[2] Hosp Galdakao, Res Unit, Galdakao, Bizkaia, Spain
[3] BIOEF, Sondika, Bizkaia, Spain
关键词
emergency department; prediction rule; severe community-acquired pneumonia;
D O I
10.1164/rccm.200602-177OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Objective strategies are needed to improve the diagnosis of severe community-acquired pneumonia in the emergency department setting. Objectives: To develop and validate a clinical prediction rule for identifying patients with severe community-acquired pneumonia, comparing it with other prognostic rules. Methods: Data collected from clinical information and physical examination of 1,057 patients visiting the emergency department of a hospital were used to derive a clinical prediction rule, which was then validated in two different populations: 719 patients from the same center and 1,121 patients from four other hospitals. Measurements and Main Results: In the multivariate analyses, eight independent predictive factors were correlated with severe community-acquired pneumonia: arterial PH < 7.30, systolic blood pressure < 90 mm Hg, respiratory rate > 30 breaths/min, altered mental status, blood urea nitrogen > 30 mg/dl, oxygen arterial pressure < 54 mm Hg or ratio of arterial oxygen tension to fraction of inspired oxygen < 250 mm Hg, age >= 80 yr, and multilobar/bilateral lung affectation. From the 0 parameter obtained in the multivariate model, a score was assigned to each predictive variable. The model shows an area under the curve of 0.92. This rule proved better at identifying patients evolving toward severe community-acquired pneumonia than either the modified American Thoracic Society rule, the British Thoracic Society's CURB-65, or the Pneumonia Severity Index. Conclusions: A simple score using clinical data available at the time of the emergency department visit provides a practical diagnostic decision aid, and predicts the development of severe community-acquired pneumonia.
引用
收藏
页码:1249 / 1256
页数:8
相关论文
共 38 条
[1]  
Alfageme I, 2005, Arch Bronconeumol, V41, P272
[2]  
Alvarez-Lerma Francisco, 2004, Curr Opin Crit Care, V10, P369
[3]  
American College of Emergency Physicians, 2001, Ann Emerg Med, V38, P107
[4]   Severe community-acquired pneumonia - Use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria [J].
Angus, DC ;
Marrie, TJ ;
Obrosky, DS ;
Clermont, G ;
Dremsizov, TT ;
Coley, C ;
Fine, MJ ;
Singer, DE ;
Kapoor, WN .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 166 (05) :717-723
[5]  
Bartlett John G., 2000, Clinical Infectious Diseases, V31, P347, DOI 10.1086/313954
[6]   THE INCIDENCE AND EFFECT ON OUTCOME OF HYPOXEMIA IN HOSPITALIZED MEDICAL PATIENTS [J].
BOWTON, DL ;
SCUDERI, PE ;
HAPONIK, EF .
AMERICAN JOURNAL OF MEDICINE, 1994, 97 (01) :38-46
[7]   Symptoms, signs, problems, and diseases of terminally ill nursing home patients - A nationwide observational study in the Netherlands [J].
Brandt, HE ;
Deliens, L ;
Ooms, ME ;
van der Steen, JT ;
van der Wal, G ;
Ribbe, MW .
ARCHIVES OF INTERNAL MEDICINE, 2005, 165 (03) :314-320
[8]   Improvement of process-of-care and outcomes after implementing a guideline for the management of community-acquired pneumonia:: A controlled before-and-after design study [J].
Capelastegui, A ;
España, PP ;
Quintana, JM ;
Gorordo, I ;
Ortega, M ;
Idoiaga, I ;
Bilbao, A .
CLINICAL INFECTIOUS DISEASES, 2004, 39 (07) :955-963
[9]   Management of community-acquired pneumonia and secular trends at different hospitals [J].
Capelastegui, A ;
España, PP ;
Quintana, JM ;
Gorordo, I ;
Gallardo, MS ;
Idoiaga, I ;
Bilbao, A .
RESPIRATORY MEDICINE, 2005, 99 (03) :268-278
[10]   Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia a Randomized trial [J].
Christ-Crain, Miriam ;
Stolz, Daiana ;
Bingisser, Roland ;
Muller, Christian ;
Miedinger, David ;
Huber, Peter R. ;
Zimmerli, Werner ;
Harbarth, Stephan ;
Tamm, Michael ;
Mueller, Beat .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 174 (01) :84-93