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.