Disease severity prediction for nursing home-acquired pneumonia in the emergency department

Man, S. Y.; Graham, Colin A.; Chan, Sik-Kwan; Mak, Pauline; Yu, AP; Cheung, Clement S.K.; Cheung, PT; Lui, Grace; Lee, Nelson; Chan, Michael; Ip, Margaret; Rainer, Timothy Hudson

doi:10.1136/emj.2010.107235

Cited by 18 publications

(38 citation statements)

References 16 publications

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“…Nineteen articles were potentially eligible after screening the titles and abstracts, 11 of which were excluded after reviewing the full texts, leaving 8 articles eventually selected [7][8][9][10][14][15][16][17] . The flowchart for the selection process is shown in Figure 1 , and the characteristics of the included studies are shown in Table 1 .…”

Section: Included Studiesmentioning

confidence: 99%

“…The size of the included studies ranged from 74 to 767 patients, and the mortality rate ranged from 12.4 to 24.1%. Two of the 8 studies were prospective observational studies [8,15] , and the other 6 were retrospective observational studies [7,9,10,14,16,17] . Seven of the 8 studies described 30-day mortality [7][8][9][10][14][15][16] , while the other described 28-day mortality [17] as the study outcome.…”

Section: Included Studiesmentioning

confidence: 99%

“…Two of the 8 studies were prospective observational studies [8,15] , and the other 6 were retrospective observational studies [7,9,10,14,16,17] . Seven of the 8 studies described 30-day mortality [7][8][9][10][14][15][16] , while the other described 28-day mortality [17] as the study outcome. Four studies evaluated patients with HCAP [7][8][9][10] , and the rest studied patients with NHAP [14][15][16][17] .…”

Section: Included Studiesmentioning

confidence: 99%

“…Seven of the 8 studies described 30-day mortality [7][8][9][10][14][15][16] , while the other described 28-day mortality [17] as the study outcome. Four studies evaluated patients with HCAP [7][8][9][10] , and the rest studied patients with NHAP [14][15][16][17] .…”

Section: Included Studiesmentioning

confidence: 99%

“…Although various studies regarding severity assessment tools for HCAP patients have been reported thus far [7][8][9][10][14][15][16][17] , no specific severity assessment tools for predicting the mortality in patients with HCAP have been developed. Some reports have suggested that the PORT score and CURB-65 may be able to be used to predict the mortality in the management of patients with HCAP [7,9] ; however, the lack of usefulness of these scoring systems has also been reported, particularly with respect to predicting mortality in low risk classes [18] .…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

et al. 2017

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Background: In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice. Objectives: In this review, we assessed the clinical significance of severity assessment tools for HCAP. Methods: We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP. Results: Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥2 and ≥3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥2 and ≥3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients. Conclusions: The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.

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Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Included Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

et al. 2017

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Predicting pneumonia mortality using CURB‐65, PSI, and patient characteristics in patients presenting to the emergency department of a comprehensive cancer center

Gonzalez¹,

Johnson

Rolston

et al. 2014

Cancer Medicine

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The prognostic accuracy of the CURB-65 criteria and pneumonia severity index (PSI) in immunocompromised cancer patients with pneumonia is unknown. We sought to determine whether CURB-65 and PSI predict 28-day mortality in cancer patients with pneumonia, and identify other factors that predispose cancer patients with pneumonia to a high mortality risk. We assessed sensitivities, specificities, predictive values, and areas under the receiver operating curve area under the curve (AUC) of the CURB-65 and PSI in predicting the 28-day mortality of cancer patients presenting to our institution's emergency department with pneumonia. We used the DeLong and Clarke–Pearson approach to determine whether the addition of other risk factors improved the scales' performances. The overall and pneumonia-related 28-day mortality rates were 20.2% (n = 44) and 17.4% (n = 38), respectively. In predicting 28-day mortality, the CURB-65 score had sensitivity of 45% and specificity of 81%, and the PSI score had sensitivity of 82% and specificity of 34%. The CURB-65 and PSI discriminated poorly between fatal and nonfatal pneumonia cases (AUCs, 0.664 and 0.658, respectively; 95% confidence interval [CI], 0.57–0.75 for each). The addition of radiation therapy (RT) within 4 weeks and stem cell transplant (SCT) significantly improved the AUCs of the CURB-65 (0.75; 95% CI, 0.67–0.83) and PSI (0.73; 95% CI, 0.65-0.82). Inadequate performances of CURB-65 and PSI demonstrate that a tool for predicting pneumonia-related mortality in cancer patients and other immunocompromised populations is needed. Pneumonia patients who have undergone recent RT or (SCT) are at a high risk of dying from pneumonia and require special consideration when assessing pneumonia-related mortality risk.

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Development and verification of a prediction model for outcomes of elderly patients with nursing home-acquired pneumonia

Zhou,

Tan,

Huo

et al. 2024

Applied Nursing Research

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Disease severity prediction for nursing home-acquired pneumonia in the emergency department

Abstract: PSI and CURB-65 are useful for identification of patients with less severe NHAP.

Cited by 18 publications

References 16 publications

Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis

Predicting pneumonia mortality using CURB‐65, PSI, and patient characteristics in patients presenting to the emergency department of a comprehensive cancer center

Development and verification of a prediction model for outcomes of elderly patients with nursing home-acquired pneumonia

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