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Published ahead of print on September 14, 2006, doi:10.1164/rccm.200602-177OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 11, December 2006, 1249-1256

A more recent version of this article appeared on December 1, 2006
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Submitted on February 7, 2006
Accepted on September 12, 2006

Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia

Pedro P Espana1*, Alberto Capelastegui1, Inmaculada Gorordo1, Cristobal Esteban1, Mikel Oribe1, Miguel Ortega2, Amaia Bilbao3, and Jose M Quintana4

1 Service of Pneumology, Hospital de Galdakao, Galdakao, Bizkaia, Spain, 2 Department of Emergency Medicine, Hospital de Galdakao, Galdakao, Bizkaia, Spain, 3 Basque Foundation for Health Innovation and Research (BIOEF), Sondika, Bizkaia, Spain, 4 Research Unit, Hospital de Galdakao, Galdakao, Bizkaia, Spain

* To whom correspondence should be addressed. 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, 8 independent predictive factors were correlated with severe community acquired pneumonia: arterial pH < 7.30; systolic blood pressure < 90 mm Hg; respiratory rate > 30/min; altered mental status; blood urea nitrogen > 30 mg/dL; oxygen arterial pressure <54 mmHg or ratio of arterial oxygen tension to fraction of inspired oxygen < 250 mm Hg; age ≥ 80 years; and multilobar/bilateral lung affectation. From the {beta} 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.
Key words: severe community-acquired pneumonia; prediction rule; emergency department.




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