Assessment of clinical applicability of pneumonia scores to determine patients with community-acquired pneumonia who will need hospital admission

Abstract

Introduction Evaluation of the severity is a main factor in dealing with community-acquired pneumonia (CAP). Pneumonia severity index (PSI) or the CURB-65 (acronym for C: confusion, U: urea, R: respiratory rate, B: blood pressure, and 65: age ≥65 years) can precisely recognize patients with a low threat of mortality. Different new scores were built to expect patients who will require admission in the ICU. Aim Our objective was to assess the clinical applicability of pneumonia scores to determine CAP patients who will be hospital admitted. Patients and methods One hundred CAP patients were subjected to routine investigations, general and local chest examination, radiological evaluation, culture and sensitivity from bronchoalveolar lavage fluid, and different pneumonia assessment scores such as PSI, CURB-65, SMRT-CO (S: systolic blood pressure, M: multilobar chest radiography involvement, R: respiratory rate, T: tachycardia, C: confusion, and O: oxygenation), and SMART-COP (acronym for S: systolic blood pressure, M: multilobar infiltrates, A: albumin, R: respiratory rate, T: tachycardia, C: confusion, O: oxygen, and P: pH). Results Sensitivities for predicting the need for mechanical ventilation with the PSI and the CURB-65 were 50 and 60%, respectively, while sensitivity for SMART-COP and SMRT-CO was 50 and 85%, respectively, with the highest specificity of 88.67% was for the SMART-COP. Sensitivities for predicting the need for intensive respiratory or vasopressor support (IRVS) with the PSI and the CURB-65 were 53.85 and 65.38%, respectively, while sensitivity for SMART-COP and SMRT-CO was 53.85 and 88.46%, respectively, with the highest specificity of 100% was for the SMART-COP. Conclusion PSI and CURB-65 are less sensitive in predicting the requirement of CAP patients to be admitted in the ICU and receive IRVS. The new scores SMART-COP and SMRT-CO are more specific in predicting the requirement of those patients for admission in the ICU and the necessity for IRVS. Using different risk assessment scores should not substitute doctors’ clinical judgment.