Development and validation of a clinical prediction rule for severe community-acquired pneumonia
Development and validation of a clinical prediction rule for severe community-acquired pneumonia
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DOI：
10.1164/rccm.200602-177oc
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发表时间：
2006-12-01
影响因子：
24.7
通讯作者：
Quintana, Jose M.
中科院分区：
文献类型：
--
作者：
Espana, Pedro P.;Capelastegui, Alberto;Quintana, Jose M.
目的：开发和验证一种用于诊断重症社区获得性肺炎患者的临床预测规则，并将其与其他预后规则进行比较。方法：利用从某医院急诊科就诊的1,057名患者的临床信息和体检数据，得出临床预测规则，并在两个不同的人群中进行验证：同一中心的719名患者和其他4家医院的1,121名患者。测量和主要结果：在多因素分析中，8个独立预测因素与重症社区获得性肺炎相关：动脉血气；7.30，收缩压90 mm Hg，呼吸频率30次/min，精神状态改变，血尿素氮30 mg/dl，动脉血氧分压54 mm Hg或动脉血氧分压/吸入氧分数250 mm Hg，年龄80岁，多叶/双侧肺感染。从多变量模型中获得的0参数中，为每个预测变量分配一个分数。该模型在0.92的曲线下显示了一个区域。事实证明，这一规则在识别演变为严重社区获得性肺炎的患者方面比修改后的美国胸科协会规则、英国胸科协会的CRIT-65或肺炎严重程度指数更好。结论：使用急诊科就诊时获得的临床数据进行简单评分可以提供实用的诊断决策辅助，并预测严重社区获得性肺炎的发展。
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 >= 80 yr, and multilobar/bilateral lung affectation. From the 0 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.