Infectious Disease Compendium

Community-Acquired Pneumonia Severity Calculator

From NEJM Volume 336:243-250 January 23, 1997 Number 4.

A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia Michael J. Fine et al

Risk in CAP patients: The risk factors and how they are scored

EXCLUSION CRITERIA: HIV/AIDS, chronically immunosuppressed, known iv drug use, hospitalization within 10 days, homeless or no phone, pregnant, unable to use oral medication, severe psychosocial problems, known pregnancy, current nursing home resident, severe neuromuscular disease, O2 sat < 90% or pO2 < 60 or chronically O2 dependent.

  Patient Characteristic Points Assigned
Demographic Factors (Age) Males Age (in years)
Females Age (in years) -10
Nursing home residents +10
Comorbid Illnesses Neoplastic disease +30
Liver disease +20
Congestive heart failure +10
Cerebrovascular disease +10
Renal disease +10
Physical Examination Findings Altered mental status +20
Respiratory rate 30 breaths per minute or more +20
Systolic blood pressure < 90 mm Hg +20
Temperature < 35°C or 40°C or more +15
Pulse 125 beats per minute or more +10
Laboratory findings pH < 7.35 +30
BUN > 10.7 mmol/L +20
Sodium less than 130 /L +20
Glucose > 13.9 mmol/L +10
Hematocrit < 30 percent +10
Partial pressure of arterial oxygen < 60 mm Hg +10
Pleural effusion +10

 

< 90, can treat as outpatient, > 90 admit.

Risk Class Score Mortality
Low I 51 0.1%
Low II 51 - 70 0.6%
Low III 71 - 90 0.9%
Medium IV 90 - 130 9.5%
High V > 130 26.7%

Hospitalization is recommended for class IV and V. Class III should be based on clinical judgment.

Last Update: 05/27/18.