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O Ochoa-Gondar, A Vila-Corcoles, T Rodriguez-Blanco, I Hospital, E Salsench, X Ansa, N Saun
PURPOSE: This study compares the ability of two simpler severity rules (classical CRB65 vs. proposed CORB75) in predicting short-term mortality in elderly patients with community-acquired pneumonia (CAP). METHODS: A population-based study was undertaken involving 610 patients ≥ 65 years old with radiographically confirmed CAP diagnosed between 2008 and 2011 in Tarragona, Spain (350 cases in the derivation cohort, 260 cases in the validation cohort). Severity rules were calculated at the time of diagnosis, and 30-day mortality was considered as the dependent variable...
April 2014: Infection
Olga Ochoa Gondar, Angel Vila Córcoles, Teresa Rodriguez Blanco, Cinta de Diego Cabanes, Elisabet Salsench Serrano, Inmaculada Hospital Guardiola
OBJECTIVE: To compare the ability of the classic CRB65 (confusion, respiratory rate, blood pressure and age ≥65 years) vs the modified CRB-75 for the severity assessment of patients 65 years or older with community acquired pneumonia (CAP). DESIGN: Prospective cohort study. SETTING: Tarragona Health Region. PARTICIPANTS: A total of 350 patients ≥65 years with a radiographically confirmed CAP (hospitalized or outpatient) during 2008-2010...
April 2013: Atencion Primaria
James D Chalmers, Julia Rutherford
Outpatient management of community-acquired pneumonia (CAP) has several potential advantages, including significant cost-savings, a reduction in hospital-acquired infections and increased patient satisfaction. Despite the benefits, it is often difficult to identify which patients may be managed in the community without compromising patient safety. CAP severity scores, such as the pneumonia severity index (PSI) and the British Thoracic Society CURB65/CRB65 scores are designed to identify groups of patients at low risk of mortality who may be suitable for outpatient care...
July 2012: European Journal of Internal Medicine
L Witte, D Drömann
Severe community-acquired pneumonia and hospital-acquired pneumonia are common infectious diseases in Germany. They are associated with high mortality especially in the old and multimorbid patient and are thus a challenge in daily clinical practice. While the CRB65 is a thoroughly validated score for risk stratification in community-acquired pneumonia, there is no comparable score for hospital-acquired pneumonia yet. Early initiation of adequate antibiotic treatment is essential for a positive outcome. Hospital-acquired pneumonia is more often associated with multidrug-resistant bacteria, which should be considered in the choice of initial treatment especially if the patient can be considered a member of a risk group...
March 2012: Medizinische Klinik, Intensivmedizin und Notfallmedizin
A R Akram, J D Chalmers, A T Hill
INTRODUCTION: In community-acquired pneumonia, severity assessment tools, such as CRB65, CURB65 and Pneumonia Severity Index (PSI), have been promoted to increase the proportion of patients treated in the community. The prognostic accuracy of these scores is established in hospitalized patients, but less is known about their use in out-patients. We aimed to study the accuracy of these severity tools to predict mortality in patients managed as out-patients. METHODS: We performed a systematic review and meta-analysis according to MOOSE guidelines...
October 2011: QJM: Monthly Journal of the Association of Physicians
James D Chalmers, Pallavi Mandal, Aran Singanayagam, Ahsan R Akram, Gourab Choudhury, Philip M Short, Adam T Hill
BACKGROUND: The aim of this meta-analysis was to determine if severity assessment tools can be used to guide decisions regarding intensive care unit (ICU) admission of patients with community-acquired pneumonia. METHODS: A search of PUBMED and EMBASE (1980-2009) was conducted to identify studies reporting pneumonia severity scores and prediction of ICU admission. Two reviewers independently collected data and assessed study quality. Performance characteristics were pooled using a random-effects model...
September 2011: Intensive Care Medicine
Andrew Morris
No abstract text is available yet for this article.
April 19, 2011: Annals of Internal Medicine
Jian-sheng Li, Su-yun Li, Xue-qing Yu, Zi-kai Sun, Wei Zhang, Xin-hua Jia, Si-ping Zheng, Ming-hang Wang, Hai-feng Wang
OBJECTIVE: To develop and validate a clinical rule to predict treatment failure in middle-aged and elderly patients suffering from community-acquired pneumonia (CAP) in China, and to compare it with other prognostic rules. METHODS: Data of 58 variables affiliated to 6 aspects, including demographics, underlaying diseases, previous status, complications, symptoms, signs and laboratory examination results from the CAP patients aged≥45 years admitted to the respiratory departments in three university affiliated hospitals between December 17, 2006 and December 22, 2008 were enrolled prospectively and then validated in two groups to create a derivation cohort with 75% of the patients for rule development and an internal validation cohort with the other 25% for internal test...
January 2011: Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, Chinese Critical Care Medicine, Zhongguo Weizhongbing Jijiuyixue
Llifon Edwards, Kyle Perrin, Meme Wijesinghe, Mark Weatherall, Richard Beasley, Justin Travers
BACKGROUND AND OBJECTIVE: The CRB65 score, a risk stratification method validated for use in community-acquired pneumonia, has recently been shown to have utility in acute exacerbations of COPD (AECOPD). The objective of this study was to independently validate the CRB65 score as a predictor of mortality in patients who required hospital admission with AECOPD. METHODS: The medical records of patients admitted to Wellington Hospital with AECOPD during a 12-month period from June 2006 were reviewed...
May 2011: Respirology: Official Journal of the Asian Pacific Society of Respirology
James D Chalmers, Aran Singanayagam, Ahsan R Akram, Pallavi Mandal, Philip M Short, Gourab Choudhury, Victoria Wood, Adam T Hill
INTRODUCTION: International guidelines recommend a severity-based approach to management in community-acquired pneumonia. CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended severity scores. The aim of this study was to compare the performance characteristics of these scores for predicting mortality in community-acquired pneumonia. METHODS: A systematic review and meta-analysis was conducted according to MOOSE (meta-analysis of observational studies in epidemiology) guidelines...
October 2010: Thorax
A Tessmer, T Welte, P Martus, M Schnoor, R Marre, N Suttorp
OBJECTIVES: Guidelines recommend dual-therapy consisting of a beta-lactam/macrolide (BLM) for hospitalized patients with community-acquired pneumonia. Nevertheless, the superiority over beta-lactam-monotherapy (BL) remains unproven. METHODS: Analyses from an observational study initiated by the German competence network CAPNETZ were performed. RESULTS: One thousand eight hundred and fifty-four patients were treated with either BL (49.0%) or BLM (51...
May 2009: Journal of Antimicrobial Chemotherapy
J D Chalmers, A Singanayagam, M P Murray, C Scally, A Fawzi, A T Hill
BACKGROUND: The aim of this study was to identify key factors on admission predicting the development of complicated parapneumonic effusion or empyema in patients admitted with community-acquired pneumonia. METHODS: A prospective observational study of patients admitted with community-acquired pneumonia in NHS Lothian, UK, was conducted. Multivariate regression analyses were used to evaluate factors that could predict the development of complicated parapneumonic effusion or empyema, including admission demographics, clinical features, laboratory tests and pneumonia-specific (Pneumonia Severity Index (PSI), CURB65 (New onset confusion, urea >7 mmol/l, Respiratory rate > or = 30 breaths/min, Systolic blood pressure < 90 mm Hg and/or diastolic blood pressure < or = 60 mm Hg and age > or = 65 years) and CRB65 (New onset confusion, Respiratory rate > or = 30 breaths/min, Systolic blood pressure <90 mm Hg and/or diastolic blood pressure < or = 60 mm Hg and age > or = 65 years)) and generic sepsis scoring systems (APACHE II (Acute Physiology and Chronic Health Evaluation II), SEWS (standardised early warning score) and systemic inflammatory response syndrome (SIRS))...
July 2009: Thorax
R Menéndez, R Martínez, S Reyes, J Mensa, X Filella, M A Marcos, A Martínez, C Esquinas, P Ramirez, A Torres
BACKGROUND: Prognostic scales provide a useful tool to predict mortality in community-acquired pneumonia (CAP). However, the inflammatory response of the host, crucial in resolution and outcome, is not included in the prognostic scales. METHODS: The aim of this study was to investigate whether information about the initial inflammatory cytokine profile and markers increases the accuracy of prognostic scales to predict 30-day mortality. To this aim, a prospective cohort study in two tertiary care hospitals was designed...
July 2009: Thorax
J D Chalmers, A Singanayagam, A T Hill
INTRODUCTION: Admission blood pressure (BP) assessment is a central component of severity assessment for community acquired pneumonia. The aim of this study was to establish which readily available haemodynamic measure on admission is most useful for predicting severity in patients admitted with community acquired pneumonia. METHODS: A prospective observational study of patients admitted with community acquired pneumonia was conducted in Edinburgh, UK. The measurements compared were systolic and diastolic BP, mean arterial pressure and pulse pressure...
August 2008: Thorax
F F Zuberi, J A Khan
SETTING: Aga Khan University Hospital, Karachi, Pakistan. OBJECTIVE: To prospectively compare 30-day mortality with CURB65 and CRB65 scores and the three mortality risk groups (low, intermediate and high) based on these scores in hospitalised patients with community-acquired pneumonia (CAP). DESIGN: Longitudinal observational cohort study of adult in-patients fulfilling the definition of CAP between October 2006 and May 2007. RESULTS: A total of 137 patients was included...
April 2008: International Journal of Tuberculosis and Lung Disease
P Schuetz, M Koller, M Christ-Crain, E Steyerberg, D Stolz, C Müller, H C Bucher, R Bingisser, M Tamm, B Müller
In patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept alpha and the calibration slope beta from our calibration model...
December 2008: Epidemiology and Infection
Katherine E Kollef, Richard M Reichley, Scott T Micek, Marin H Kollef
OBJECTIVE: To compare the predictive accuracy for 30-day mortality of the CURB65 score adopted by the British Thoracic Society and the simpler CRB65 score to APACHE (acute physiology and chronic health evaluation) II in patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. DESIGN: A retrospective, single-center, observational cohort study. SETTING: Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital. PATIENTS: Adult patients requiring hospitalization identified to have MRSA pneumonia...
February 2008: Chest
Shin Yan Man, Nelson Lee, Margaret Ip, Gregory E Antonio, Shirley S L Chau, Paulina Mak, Colin A Graham, Mingdong Zhang, Grace Lui, Paul K S Chan, Anil T Ahuja, David S Hui, Joseph J Y Sung, Timothy H Rainer
BACKGROUND: Community-acquired pneumonia (CAP) is a leading infectious cause of death throughout the world, including Hong Kong. AIM: To compare the ability of three validated prediction rules for CAP to predict mortality in Hong Kong: the 20 variable Pneumonia Severity Index (PSI), the 6-point CURB65 scale adopted by the British Thoracic Society and the simpler CRB65. METHODS: A prospective observational study of 1016 consecutive inpatients with CAP (583 men, mean (SD) age 72 (17) years) was performed in a university hospital in the New Territories of Hong Kong in 2004...
April 2007: Thorax
Gavin Barlow, Dilip Nathwani, Peter Davey
BACKGROUND: The performance of CURB65 in predicting mortality in community-acquired pneumonia (CAP) has been tested in two large observational studies. However, it has not been tested against generic sepsis and early warning scores, which are increasingly being advocated for identification of high-risk patients in acute medical wards. METHOD: A retrospective analysis was performed of data prospectively collected for a CAP quality improvement study. The ability to stratify mortality and performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating curve) were calculated for stratifications of CURB65, CRB65, the systemic inflammatory response syndrome (SIRS) criteria and the standardised early warning score (SEWS)...
March 2007: Thorax
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