2181. Outcomes of Patients with Community Acquired Pneumonia Using the Pneumonia Severity Index Versus the CURB-65 as Severity Assessment Tool in Routine Practice of Emergency Departments

Abstract

Abstract Background The Pneumonia Severity Index (PSI) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score can assess the severity in patients with community acquired pneumonia (CAP). We compared the clinical performance of both prognostic scores according to clinical outcome and admission rates. Methods A nationwide observational cohort study was conducted using claims data from adult patients presenting to the emergency department (ED) with CAP in 2018 and 2019. Dutch hospitals were divided into three categories: ‘CURB-65 hospitals’ (n=25), ‘PSI hospitals’ (n=19) and hospitals using both (‘no-consensus hospitals’, n=15). Main outcomes were number of hospital admissions, intensive care unit (ICU) admissions, length of hospital stay, and all-cause 30-day mortality. Multilevel logistic and Poisson regression analysis were used to adjust for potential confounders, including age, gender, comorbidities, medical specialism, and type of hospital. Results Of the 51.241 included patients with CAP at the ED, 21.233 were treated in CURB-65 hospitals, 17.389 in PSI hospitals and 12.619 in no-consensus hospitals. The 30-day mortality rate was 8·6% in CURB-65 hospitals versus 9·7% in PSI hospitals. Adjusted odds ratios (aORs) for 30-day mortality were lower in CURB-65 hospitals than in PSI hospitals (aOR 0·88, 95% confidence interval (CI): 0·82-0·95, p = 0·002). The admission rates in CURB-65 and PSI hospitals were similar (77·2% and 79·9%, aOR 0·81, 95% CI: 0·64-1·02). No-consensus hospitals had slightly higher admission rates on average compared to the CURB-65 and PSI hospitals combined (78·4% and 81·5%, aOR 0·79, 95% CI: 0·62-1·0). Conclusion The routine use of CURB-65 for risk assessment in CAP patients presenting to the ED in the Netherlands is associated with lower 30-day mortality. After further confirmation, the CURB-65 may be recommended over the use of the PSI. Disclosures W. Joost Wiersinga, PhD, AstraZeneca: Honoraria|GSK (DSMB): Honoraria|Pfizer: Honoraria|Sobi: Honoraria.