A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia
A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia
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DOI：
10.1136/thx.2005.051326
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发表时间：
2006-05-01
期刊：
影响因子：
10
通讯作者：
Brown, GV
中科院分区：
文献类型：
--
作者：
Buising, KL;Thursky, KA;Brown, GV
背景：已经提出了几种严重程度评分来预测患者的预后并指导社区获得性肺炎（CAP）患者的初始管理。大多数都是作为死亡率的预测指标。进行了一项研究，以比较这些工具的预测价值，使用不同的临床有意义的结果作为“严重肺炎”的结构。方法：对2003年3月至2004年3月入院诊断为CAP的所有急诊科患者进行前瞻性队列研究。使用肺炎严重程度指数（PSI）、修订后的美国胸科协会评分（rATS）和英国胸科协会（BTS）严重程度评分（CURB）、修订后的BTS严重程度评分和CURB-65来计算患者的严重程度评分。对四种不同结局（死亡、需要ICU住院、死亡和/或需要通气或肌力支持的综合结局）的敏感性、特异性、阳性和阴性预测值进行比较。结果：392例患者纳入分析；37例（9.4%）死亡，26例（6.6%）需要通气和/或肌力支持。改良后的BTS严重程度评分在所有四个结果中表现最好。PSI （IV+V类）和CURB作为预测工具对每个结果的表现非常相似。大鼠很好地确定了ICU住院的需要，但没有确定死亡率。CURB-65评分可以很好地预测死亡率，但当对ICU的需求包括在感兴趣的结果时，其预测效果较差。当评估综合结果时（排除年龄在100 - 90岁之间的患者和来自养老院的患者），最好的预测因子是改良的BTS严重程度评分（敏感性94.3%）和PSI和CURB评分（两者的敏感性83.3%）。结论：不同的严重程度评分作为预测工具有不同的优缺点。应该在最相关的临床环境中进行验证，使用更合适的“严重肺炎”结构，以确保这些潜在有用的工具真正达到临床医生的期望。
Background: Several severity scores have been proposed to predict patient outcome and to guide initial management of patients with community acquired pneumonia (CAP). Most have been derived as predictors of mortality. A study was undertaken to compare the predictive value of these tools using different clinically meaningful outcomes as constructs for "severe pneumonia''.Methods: A prospective cohort study was performed of all patients presenting to the emergency department with an admission diagnosis of CAP from March 2003 to March 2004. Clinical and laboratory features at presentation were used to calculate severity scores using the pneumonia severity index (PSI), the revised American Thoracic Society score (rATS), and the British Thoracic Society (BTS) severity scores CURB, modified BTS severity score, and CURB-65. The sensitivity, specificity, positive and negative predictive values were compared for four different outcomes (death, need for ICU admission, and combined outcomes of death and/or need for ventilatory or inotropic support).Results: 392 patients were included in the analysis; 37 (9.4%) died and 26 (6.6%) required ventilatory and/or inotropic support. The modified BTS severity score performed best for all four outcomes. The PSI (classes IV+V) and CURB had a very similar performance as predictive tools for each outcome. The rATS identified the need for ICU admission well but not mortality. The CURB-65 score predicted mortality well but performed less well when requirement for ICU was included in the outcome of interest. When the combined outcome was evaluated (excluding patients aged > 90 years and those from nursing homes), the best predictors were the modified BTS severity score (sensitivity 94.3%) and the PSI and CURB score (sensitivity 83.3% for both).Conclusions: Different severity scores have different strengths and weaknesses as prediction tools. Validation should be done in the most relevant clinical setting, using more appropriate constructs of "severe pneumonia'' to ensure that these potentially useful tools truly deliver what clinicians expect of them.