see:
- [Utility of community-acquired pneumonia severity scores in guiding disposition from the emergency department: Intensive care or short-stay unit](bookends://sonnysoftware.com/ref/DL/86709)
- [Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis.](bookends://sonnysoftware.com/ref/DL/291530)
- [RMH study on CORB 2007: Identifying severe community-acquired pneumonia in the emergency department: a simple clinical prediction tool.](bookends://sonnysoftware.com/ref/DL/277894)
[Dunn - Pneumonia Scoring systems](x-devonthink-item://F66576C0-CDD5-4EF4-B0DE-37E3C6281A01)
- In general, scores are better at predicting severe disease than mild disease
- there is [considerable variability]([Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.](bookends://sonnysoftware.com/ref/DL/240511)) between different ED physician choices about pneumonia admission
| Score | Best use | Benefits | Limitations |
| --------- | ------------------------------------ | ----------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| CURB-65 | predict mortality | - specific for severe disease<br>- well-validated | - less sensitive than SMART-COP<br>- may underestimate severity in young, over-estimate in old<br>- There is an obvious limitation of using 30-day mortality as an endpoint for determining the appropriateness for outpatient medical treatment, such as was used to validate CURB-65 and PSI. For example, the 30-day mortality of low severity appendicitis patients who received hospital treatment will be significantly lower than for those who receive outpatient treatment, since the surgery they receive in hospital to treat appendicitis will modify their 30-day mortality risk. Indeed, the authors of the CORB tool also acknowledge that “medical intervention influences patient outcomes,” and therefore identified a requirement for ICU as a more important outcome for measuring disease severity than mortality. |
| SMART-COP | predict need for ICU | - useful for identifying severe CAP<br>- focus on pneumonia clinical severity rather than risk factors | - does not estimate mortality<br>- other variables eg age, co-morbidity may still make ICU indicated<br>- complex to calculate |
| CORB | predict need for ICU/ severe disease | - easiest to perform<br>- specific for severe disease<br>- CORB 0 pneumonia had a 95% NPV for “severe” pneumonia. | - not great at identifying low-risk pneumonia appropriate for discharge (CORB >0 likely needs admission)<br>- ~10% of pts with CORB <2 die<br>- low CORB only 38% specific for predicting discharge within 48 hours without death or readmission at 30 days. |
| PSI | predict mortality | - decent at identifying low-risk CAP | - very difficult to perform (20 variables)<br>- see comment in CURB-65 regarding limitations of 30-day mortality as a metric for deciding the need for hospital admission |
## CURB 65
C - confusion - 1
U - urea > 7 - 1
R - RR ≥ 30 - 1
B - SBP ≤ 90 or diastolic ≤ 60 - 1
65 - age > 65
> score ≥ 2 = 7.6% 30-day mortality
### CRB-65
modification that doesn't require urea
likely performs equally well as CURB-65 and PSI
## SMARTCOP
> - use in pts with CAP who may require ICU
> - does not estimate mortality
score ≥ 7 points = 50% risk of needing intensive resp support or vasopressor support
- S - Systolic BP < 90 - 2
- M - multilobar - 1
- A - albumin < 35 - 1
- R - ↑ - 1
- age ≤ 50 RR ≥ 25
- age > 50 ≥ 30
- T - tachycardia - 1
- C - confusion - 1
- O - oxygen ↓ - 2
- age ≤ 50 O2 ≤ 93% or P:F <333
- age > 40 O2 ≤ 90%
- P - pH < 7.35 - 2
## CORB
- C - confusion (acute)
- O - oxygen sat ≤ 90%
- R - RR ≥ 30
- B - systolic BP < 90 or diastolic ≤ 60
"Severe CAP" ≥ 2 (although likely admit if > 0)
## Pneumonia Severity Index (PSI)
first widely used, and now least useful scoring system
- predicts mortality
- less sensitive and specific than CURB 65
- many more variables and harder to compute than CURB 65