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Yeah, it's Pneumonia, But How Bad is it Really?

Hospital or Home? The IDSA/ATS guidelines favor the use of the Pneumonia Severity Index (PSI)(3) to determine inpatient versus outpatient treatment for community acquired pneumonia. The PSI assigns patients to five risk classes. Age greater than 50 years, select comorbidities or physiologic red flags earn a patient a minimum level II risk. If none of these apply, then the patient is risk class I and can be treated as an outpatient. Points are assigned for the noted comorbidities as well as physiologic parameters to generate a final score, risk class and recommendations for disposition in risk classes II- V.

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  PSI Score

Community-acquired pneumonia severity index (PSI) for adults.

Articles of Interest

A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients...

Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia,

A simplified pneumonia severity index (PSI) for clinical outcome prediction in COVID-19

The Pneumonia Score Index (PSI) was developed to estimate the risk of dying within 30 days of presentation for community-acquired pneumonia patients and is a strong predictor of 30-day mortality after COVID-19. However, three of its required 20 variables (skilled nursing home, altered mental status and pleural effusion) are not discreetly available in the electronic medical record (EMR), resulting in manual chart review for these 3 factors. The goal of this study is to compare a simplified 17-factor version (PSI-17) to the original (denoted PSI-20) in terms of prediction of 30-day mortality in COVID-19.

Pneumonia Severity Index (PORT Score)

The pneumonia severity index (PSI) is also known as the PORT score, PORT being a subset of the validation cohort. It was derived based on data from 14,199 adult patients and subsequently validated on over 40,000 patients in the United States and Canada. HIV-positive patients and those with a recent admission for pneumonia were excluded. A simpler score, known as the CURB-65 score, has also been prospectively validated.

PSI/PORT Score: Pneumonia Severity Index for Community-Acquired Pneumonia

The pneumonia severity index (PSI), or pneumonia Patient Outcomes Research Team (PORT) score, can be used in the emergency department setting to risk stratify patients who present with community-acquired pneumonia. In most situations, however, the CURB-65 score is easier to use and requires fewer inputs. Because the PSI assigns points by absolute age, it may underestimate severe pneumonia in an otherwise healthy young patient. Patients aged >50 years are automatically classified as risk class 2, even if they have no additional risk criteria. It is recommended that clinicians consider sepsis in patients with pneumonia. The PSI was developed prior to aggressive sepsis screening with lactate testing. For patients scoring high on the PSI, it would be prudent to ensure that initial triage has not missed the presence of sepsis. Evaluation for systemic inflammatory response syndrome criteria would be beneficial for these patients.

The Battle of the Pneumonia Predictors

It was seen that the two severity scores are the most preferred tools in the prediction of ICU admission and mortality. However, despite having comparable mortality, CURB-65 is highly preferred as it is easier to implement apart from everything else. Finally, even though these two scores are helpful tools, they cannot and should not be used in place of clinical judgment and medical examination.

Resources

PSI/PORT Score

Estimates mortality for adult patients with community-acquired pneumonia.