The Clinical Impact of the Pneumonia Severity Index and the CURB-65 for Making Admission Decisions

Jo, Jeong Ryul; Jin, Young Ho; Jeong, Tae Oh; Lee, Jae Bak

Abstract

PURPOSE
The aim of our study was to examine the discrepancies between the Pneumonia Severity Index (PSI) score, the CURB-65 [confusion, blood urea nitrogen, respiratory rate and blood pressure with age (65 years)] and the clinical judgment for making admission decisions, and we also wanted to evaluate the value of the PSI and CURB-65 as the indicators for detecting inappropriate hospitalization among the patients with low risk CAP.
METHODS
The medical records of 286 patients who visited the emergency department with CAP were identified by their PSI and their CURB-65, and we reviewed whether there existed a clinical basis to justify their hospitalization.
RESULTS
Of a total 286 patients, 225 patients were admitted to the hospital. Sixty five patients with a PSI of I or II, and 117 patients with a CURB-65 of 0 or 1 were admitted by clinical judgment. The factors that justified admission of a lower risk CAP group were medical conditions other than CAP (56.9% vs 70.1%; PSI vs CURB-65), failure of outpatient therapy (24.6% vs 19.6%), social needs (6.2% vs 2.6%) and hypoxemia in 1 patient (1.5% vs 0.9%, respectively). Of the patients in the low risk group according to the CURB-65, one five patient was hospitalized for suspicion of sepsis. The positive predicted values of the PSI and CURB- 65 for inappropriate hospitalization of low risk CAP patients were 10.8% and 5.9%, respectively.
CONCLUSION
The PSI and CURB-65 had unacceptably low positive predictive values and this was due to the comorbid conditions that required in-hospital care for the patients with low risk CAP. These indices did not supersede clinical judgment for making the decision to hospitalize low risk patients with CAP.