Pneumonia diagnostic algorithm: Difference between revisions
Jump to navigation
Jump to search
Hamid Qazi (talk | contribs) No edit summary |
|||
| Line 66: | Line 66: | ||
</div> | </div> | ||
{{clr}} | {{clr}} | ||
==CURB-65 Clinical Prediction Rule== | |||
CURB-65 is a [[clinical prediction rule]] that has been validated for predicting mortality in [[community-acquired pneumonia]]<ref name="pmid12728155">{{cite journal |author=Lim WS, van der Eerden MM, Laing R, ''et al'' |title=Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study |journal=Thorax |volume=58 |issue=5 |pages=377-82 |year=2003 |pmid=12728155 |doi=}}</ref> and infection of any site<ref name="pmid17576773">{{cite journal |author=Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI |title=Performance of severity of illness scoring systems in emergency department patients with infection |journal=Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |volume=14 |issue=8 |pages=709-14 |year=2007 |pmid=17576773 |doi=10.1197/j.aem.2007.02.036}}</ref>. The CURB-65 is based on the earlier CURB score<ref name="pmid11254821">{{cite journal |author=Lim WS, Macfarlane JT, Boswell TC, ''et al'' |title=Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines |journal=Thorax |volume=56 |issue=4 |pages=296-301 |year=2001 |pmid=11254821 |doi=}}</ref> and is recommended by the [[British Thoracic Society]] for the assessment of severity of pneumonia.<ref name="pmid11713364">{{cite journal |author= |title=BTS Guidelines for the Management of Community Acquired Pneumonia in Adults |journal=Thorax |volume=56 Suppl 4 |issue= |pages=IV1-64 |year=2001 |pmid=11713364 |doi=}}</ref> | |||
===Calculation of CURB-65=== | |||
The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5: | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
|style="padding: 0 5px; font-size: 100%; background: #4479BA; color: #FFFFFF;" align=center |'''Criteria''' || style="padding: 0 5px; font-size: 100%; background: #4479BA; color: #FFFFFF;" align=center |'''Score''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''C'''onfusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less)|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |1 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''U'''rea greater than 7 mmol/l (Blood Urea Nitrogen > 20)||style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left | 1 | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''R'''espiratory rate of 30 breaths per minute or greater|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |1 | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''B'''lood pressure less than 90 systolic or diastolic blood pressure 60 or less||style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left | 1 | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |Age '''65''' or older|| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |1 | |||
|} | |||
===Interpretation of CURB-65: Risk of Death from Pneumnoia=== | |||
The risk of death increases as the score increases. | |||
{| style="border: 0px; font-size: 85%; margin: 3px; width:200px;" align=center | |||
|valign=top| | |||
|+ | |||
! style="background: #4479BA; color:#FFF; width: 200px;" | CURB-65 Score | |||
! style="background: #4479BA; color:#FFF; width: 200px;" | Risk of death | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 0 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |0.7% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 1 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |3.2% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 2 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |13.0% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 3 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |17.0% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 4 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |41.5% | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;text-align:center;font-weight: bold" | 5 | |||
| style="padding: 5px 5px; background: #F5F5F5;text-align:center;" |57.0% | |||
|} | |||
The CURB-65 has been compared to the [[pneumonia severity index]] in predicting mortality from pneumonia.<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref> | |||
===Interpretation of CURB-65: Risk of Death from any Infection=== | |||
A [[cohort study]] of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases<ref name="pmid17576773"/>: | |||
* 0 to 1 <5% mortality | |||
* 2 to 3 < 10% mortality | |||
* 4 to 5 15-30% mortality | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 17:12, 23 February 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
|
Pneumonia Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pneumonia diagnostic algorithm On the Web |
|
American Roentgen Ray Society Images of Pneumonia diagnostic algorithm |
|
Risk calculators and risk factors for Pneumonia diagnostic algorithm |
Diagnostic Algorithm
Shown below is an algorithm for the diagnostic approach of pneumonia.[1]
[2]
Abbreviations: HCAP: Healthcare-associated pneumonia; CAP: Community-acquired pneumonia; VAP: Ventilator-associated pneumonia; HAP: Hospital-acquired pneumonia; AMT: Abbreviated mental test score
Physical Examination Findings: | |||||||||||||||||||||||||||||||||||||
Order Labs: ❑ Complete blood count (CBC) ❑ Blood urea nitrogen (BUN) ❑ Sputum gram stain and culture ❑ Blood culture and ABG if necessary If atypical pneumonia is suspected, obtain:
| |||||||||||||||||||||||||||||||||||||
❑ Order a chest X-ray if the patient presents with any of the following:[3]
| |||||||||||||||||||||||||||||||||||||
Does the patient meets any of the following criteria for HCAP?[4]
| |||||||||||||||||||||||||||||||||||||
YES | NO The patient has CAP | ||||||||||||||||||||||||||||||||||||
Does the infection occurred ≥48 hours after admission and it was not present at admission? | Does the patient has at least 2 of the following CURB65 criteria?
| ||||||||||||||||||||||||||||||||||||
NO The patient has HCAP | |||||||||||||||||||||||||||||||||||||
CURB-65 Clinical Prediction Rule
CURB-65 is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia[5] and infection of any site[6]. The CURB-65 is based on the earlier CURB score[7] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[8]
Calculation of CURB-65
The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:
| Criteria | Score |
| Confusion (defined as an AMT of 8 or less) | 1 |
| Urea greater than 7 mmol/l (Blood Urea Nitrogen > 20) | 1 |
| Respiratory rate of 30 breaths per minute or greater | 1 |
| Blood pressure less than 90 systolic or diastolic blood pressure 60 or less | 1 |
| Age 65 or older | 1 |
Interpretation of CURB-65: Risk of Death from Pneumnoia
The risk of death increases as the score increases.
| CURB-65 Score | Risk of death |
|---|---|
| 0 | 0.7% |
| 1 | 3.2% |
| 2 | 13.0% |
| 3 | 17.0% |
| 4 | 41.5% |
| 5 | 57.0% |
The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia.[9]
Interpretation of CURB-65: Risk of Death from any Infection
A cohort study of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases[6]:
- 0 to 1 <5% mortality
- 2 to 3 < 10% mortality
- 4 to 5 15-30% mortality
References
- ↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
- ↑ Solomon, Caren G.; Wunderink, Richard G.; Waterer, Grant W. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 370 (6): 543–551. doi:10.1056/NEJMcp1214869. ISSN 0028-4793.
- ↑ Watkins RR, Lemonovich TL (2011). "Diagnosis and management of community-acquired pneumonia in adults". Am Fam Physician. 83 (11): 1299–306. PMID 21661712.
- ↑ Attridge RT, Frei CR (2011). "Health care-associated pneumonia: an evidence-based review". The American Journal of Medicine. 124 (8): 689–97. doi:10.1016/j.amjmed.2011.01.023. PMID 21663884. Retrieved 2012-09-02. Unknown parameter
|month=ignored (help) - ↑ Lim WS, van der Eerden MM, Laing R; et al. (2003). "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study". Thorax. 58 (5): 377–82. PMID 12728155.
- ↑ 6.0 6.1 Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI (2007). "Performance of severity of illness scoring systems in emergency department patients with infection". Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 14 (8): 709–14. doi:10.1197/j.aem.2007.02.036. PMID 17576773.
- ↑ Lim WS, Macfarlane JT, Boswell TC; et al. (2001). "Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines". Thorax. 56 (4): 296–301. PMID 11254821.
- ↑ "BTS Guidelines for the Management of Community Acquired Pneumonia in Adults". Thorax. 56 Suppl 4: IV1–64. 2001. PMID 11713364.
- ↑ Aujesky D, Auble TE, Yealy DM; et al. (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384–92. doi:10.1016/j.amjmed.2005.01.006. PMID 15808136.