BACKGROUND: We endeavored to construct a simple score based entirely on epidemiological and clinical variables that would stratify patients who require hospital admission because of community-acquired pneumonia into groups with a low or high risk of developing bacteremia. METHODS: Derivation and internal validation cohorts were obtained by retrospective analysis of a database that included 3116 consecutive patients with community-acquired pneumonia from 2 university hospitals. Potential predictive factors were determined by means of a multivariate logistic regression equation applied to a cohort consisting of 60% of the patients. Points were assigned to significant parameters to generate the score. It was then internally validated with the remaining 40% of patients and was externally validated using an independent multicenter cohort of 1369 patients. RESULTS: The overall rates of bacteremia were 12%-16% in the cohorts. The clinical probability estimate of developing bacteremia was based on 6 variables: liver disease, pleuritic pain, tachycardia, tachypnea, systolic hypotension, and absence of prior antibiotic treatment. For the score, 1 point was assigned to each predictive factor. In the derivation cohort, a cutoff score of 2 best identified the risk of bacteremia. In the validation cohorts, rates of bacteremia were <8% for patients with a score 1 (43%-49% of patients), whereas blood culture results were positive in 14%-63% of cases for patients with a score 2. CONCLUSIONS: This clinical score, based on readily available and objective variables, provides a useful tool to predict bacteremia. The score has been internally and externally validated and may be useful to guide diagnostic decisions for community-acquired pneumonia.
BACKGROUND: We endeavored to construct a simple score based entirely on epidemiological and clinical variables that would stratify patients who require hospital admission because of community-acquired pneumonia into groups with a low or high risk of developing bacteremia. METHODS: Derivation and internal validation cohorts were obtained by retrospective analysis of a database that included 3116 consecutive patients with community-acquired pneumonia from 2 university hospitals. Potential predictive factors were determined by means of a multivariate logistic regression equation applied to a cohort consisting of 60% of the patients. Points were assigned to significant parameters to generate the score. It was then internally validated with the remaining 40% of patients and was externally validated using an independent multicenter cohort of 1369 patients. RESULTS: The overall rates of bacteremia were 12%-16% in the cohorts. The clinical probability estimate of developing bacteremia was based on 6 variables: liver disease, pleuritic pain, tachycardia, tachypnea, systolic hypotension, and absence of prior antibiotic treatment. For the score, 1 point was assigned to each predictive factor. In the derivation cohort, a cutoff score of 2 best identified the risk of bacteremia. In the validation cohorts, rates of bacteremia were <8% for patients with a score 1 (43%-49% of patients), whereas blood culture results were positive in 14%-63% of cases for patients with a score 2. CONCLUSIONS: This clinical score, based on readily available and objective variables, provides a useful tool to predict bacteremia. The score has been internally and externally validated and may be useful to guide diagnostic decisions for community-acquired pneumonia.
Authors: Pavan K Bhatraju; Katie B Hisert; Moira L Aitken; Christopher H Goss; W Conrad Liles; William A Altemeier Journal: Ann Am Thorac Soc Date: 2019-06
Authors: Tom H Boyles; Adrian Brink; Greg L Calligaro; Cheryl Cohen; Keertan Dheda; Gary Maartens; Guy A Richards; Richard van Zyl Smit; Clifford Smith; Sean Wasserman; Andrew C Whitelaw; Charles Feldman Journal: J Thorac Dis Date: 2017-06 Impact factor: 2.895
Authors: Aaron M Harris; Anna M Bramley; Seema Jain; Sandra R Arnold; Krow Ampofo; Wesley H Self; Derek J Williams; Evan J Anderson; Carlos G Grijalva; Jonathan A McCullers; Andrew T Pavia; Richard G Wunderink; Kathryn M Edwards; Jonas M Winchell; Lauri A Hicks Journal: Open Forum Infect Dis Date: 2017-02-10 Impact factor: 3.835
Authors: Dheeraj Gupta; Ritesh Agarwal; Ashutosh Nath Aggarwal; Navneet Singh; Narayan Mishra; G C Khilnani; J K Samaria; S N Gaur; S K Jindal Journal: Lung India Date: 2012-07