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Disease severity prediction for nursing home-acquired pneumonia in the emergency department
  1. S Y Man1,
  2. C A Graham1,
  3. S S W Chan1,
  4. P S K Mak1,
  5. A H Y Yu1,
  6. C S K Cheung1,
  7. P S Y Cheung1,
  8. G Lui2,
  9. N Lee2,
  10. M Chan3,
  11. M Ip4,
  12. T H Rainer1
  1. 1Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
  2. 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
  3. 3Department of Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
  4. 4Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
  1. Correspondence to Professor T H Rainer, Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Trauma & Emergency Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR; thrainer{at}cuhk.edu.hk

Abstract

Background Prediction rules exist for the assessment of community-acquired pneumonia but their use in nursing home-acquired pneumonia (NHAP) remains undefined. The objectives of this study were to compare the prognostic ability for severe NHAP of five prediction rules (PSI, CURB-65, M-ATS, R-ATS, España rule), and to evaluate their usefulness to identify patients with less severe disease in the emergency department for outpatient care.

Methods A prospective observational study of consecutive NHAP patients was conducted at a university teaching hospital emergency department in Hong Kong between January 2004 and June 2005. The primary outcome was severe pneumonia (defined as combined 30-day mortality and/or intensive care unit (ICU) admission).

Results 767 consecutive NHAP patients were included. Mean (SD) age was 83.4 (9.0) years; 350 (45.6%) were male and 644 (84.0%) had coexisting illness. 95 patients died within 30 days (12.4%), five patients were admitted to the ICU (0.7%) and 98 patients had severe pneumonia (12.8%). Sensitivity and specificity of each decision rule ranged from 37.8% to 95.9% and 15.1% to 87.6% respectively. The overall predictive performance of each rule was between 0.627 and 0.712. The negative likelihood ratios of PSI (0.27) and CURB-65 (0.23) were lower than M-ATS (0.71), R-ATS (0.45) and España (0.39). After excluding 204 patients with either poor functional status or those >90 years of age, sensitivities of M-ATS (96.0%) and R-ATS (100%) improved greatly with negative likelihood ratios of <0.1.

Conclusion PSI and CURB-65 are useful for identification of patients with less severe NHAP.

  • Infectious diseases
  • respiratory
  • pneumonia
  • pneumonia/infections

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Footnotes

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Institutional Review Boards of the Hospital Authority of Hong Kong and the Chinese University of Hong Kong.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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