Published ahead of print on September 14, 2006, doi:10.1164/rccm.200602-177OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200602-177OC
Development and Validation of a Clinical Prediction Rule for Severe Community-acquired PneumoniaService of Pneumology, Department of Emergency Medicine, and Research Unit, Hospital de Galdakao, Galdako; and Basque Foundation for Health Innovation and Research (BIOEF), Sondika, Bizkaia, Spain Correspondence and requests for reprints should be addressed to Pedro P. España, M.D., Service of Pneumology, Hospital de Galdakao, 48960 Galdakao, Bizkaia, Spain. E-mail: pespana{at}hgda.osakidetza.net 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 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.
Key Words: emergency department • prediction rule • severe community-acquired pneumonia
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80 yr, and multilobar/bilateral lung affectation. From the 
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. 
