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 | | 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 | - not great at identifying low-risk pneumonia appropriate for discharge (CORB >0 likely needs admission) | | PSI | predict mortality | - decent at identifying low-risk CAP | - very difficult to perform (20 variables) | ## 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