Pulmonology Book

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Pneumonia Severity Index

Aka: Pneumonia Severity Index, Pneumonia Hospitalization Criteria
  1. See Also
    1. Pneumonia
    2. Pneumonia Management
    3. Pneumonia Hospitalization Criteria in the Elderly
  2. Indication: Community Acquired Pneumonia
    1. Triages patients to outpatient or inpatient management
  3. Criteria
    1. General
      1. Age in years: ADD 1 point per year
      2. Gender: SUBTRACT 10 points for women
      3. Nursing Home resident: ADD 10 points
    2. Past medical history
      1. Cancer: ADD 30 points
      2. Liver Disease: ADD 20 points
      3. CHF: ADD 10 points
      4. CVA: ADD 10 points
      5. Chronic Kidney Disease: ADD 10 points
    3. Examination findings
      1. Altered Level of Consciousness: ADD 20 points
      2. Breathing Rate >30 rpm: ADD 20 points
      3. Systolic BP <90 mmHg: ADD 20 points
      4. Temperature not 95-104 F (35-40 C): Add 15 points
      5. Heart Rate >125 bpm: ADD 10 points
    4. Labs: Arterial Blood Gas (ABG)
      1. Arterial pH <7.35: ADD 30 points
      2. PaO2 <60 mmHg (<90% O2 Sat): ADD 10 points
    5. Labs: Serum Chemistry
      1. Serum Sodium <130 mEq/L: ADD 20 points
      2. Blood Urea Nitrogen (BUN) >64 mg/dl: ADD 20 points
      3. Serum Glucose >250 mg/dl: ADD 10 points
    6. Labs: Blood Count
      1. Hematocrit <30%: ADD 10 points
    7. Chest XRay
      1. Pleural Effusion: ADD 10 points
  4. Scoring
    1. Class 1: Points 0: Mortality 0.1% (low risk)
    2. Class 2: Points <70: Mortality 0.6% (low risk)
    3. Class 3: Points 71-90: Mortality 2.8% (low risk)
    4. Class 4: Points 91-130: Mortality 8.2% (moderate risk)
    5. Class 5: Points >130: Mortality 29.2% (high risk)
  5. Interpretation
    1. Class 1-2: Outpatient management
    2. Class 3: Consider short observation hospital stay
    3. Class 4-5: Inpatient management
  6. References
    1. Fine (1997) N Engl J Med 336: 243-50 [PubMed]

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