Clinical research studyProspective comparison of three validated prediction rules for prognosis in community-acquired pneumonia
Section snippets
Study sites and patients
This study was conducted between January and December 2001 as part of a clinical trial to assess the effectiveness of 3 practice guideline implementation strategies (low, moderate, and high intensity) for pneumonia in 32 hospital emergency departments in Pennsylvania (n = 16) and Connecticut (n = 16).19 The institutional review boards of all participating study sites approved all study procedures. The study design and characteristics of participating emergency departments were described
Study sample
Of the 4506 identified patients with pneumonia who met eligibility criteria, 3615 (80%) were initially enrolled. Nonenrolled individuals tended to be older (mean age 74 vs. 63 years) and more likely to be resident in nursing homes (36% vs. 4.9%) than enrolled patients. After excluding 434 patients who either failed to meet eligibility criteria based on chart review (n = 293), were missing follow-up information for 30-day mortality (n = 57), lacked documentation of informed consent (n = 33),
Discussion
Our comparison shows that the Pneumonia Severity Index has a higher discriminatory power for predicting 30-day mortality than either CURB severity score. Low-risk patients identified using the Pneumonia Severity Index have a slightly lower mortality and a slightly higher negative predictive value for death than low-risk patients identified using either CURB severity score. Even when the CURB severity scores were converted into more complex, 2-step prediction rules using the Pneumonia Severity
Acknowledgments
The authors would like to acknowledge the important contributions of the individuals listed below for serving the following key roles on the project:
Study Site Investigators. These individuals were responsible for facilitating the initiation and conduct of the trial at the local hospital level:
Connecticut: Michael L. Carius, MD, Thomas Ceddia, MD, Ian Cummings, MD, Robert Femia, MD, Bernard J. Ferguson IV, MD, William Gemmell, MD, Robert J. Grant, MD, Steven T. Holland, MD, Thomas J. Koobatian,
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This study was supported by grant RO1 HS10049-03 from the Agency for Healthcare Research and Quality, Rockville, Maryland. Dr. Aujesky was supported in part by the Novartis Research Foundation and Dr. MJ Fine was supported in part by a K24 career development award from the National Institute of Allergy and Infectious Diseases.