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.
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.
Authors: Syed Imran Ayaz; Nadia Haque; Claire Pearson; Patrick Medado; Duane Robinson; Robert Wahl; Marcus Zervos; Brian J O'Neil Journal: Int J Emerg Med Date: 2014-05-12
Authors: Carmen Gonzalez; Tami Johnson; Kenneth Rolston; Kelly Merriman; Carla Warneke; Scott Evans Journal: Cancer Med Date: 2014-05-07 Impact factor: 4.452
Authors: Lee Hooper; Asmaa Abdelhamid; Sarah M Ajabnoor; Chizoba Esio-Bassey; Julii Brainard; Tracey J Brown; Diane Bunn; Eve Foster; Charlotte C Hammer; Sarah Hanson; Florence O Jimoh; Hassan Maimouni; Manraj Sandhu; Xia Wang; Lauren Winstanley; Jane L Cross; Ailsa A Welch; Karen Rees; Carl Philpott Journal: Clin Nutr ESPEN Date: 2021-11-19
Authors: M Bernabeu-Wittel; J E Ternero-Vega; P Díaz-Jiménez; C Conde-Guzmán; M D Nieto-Martín; L Moreno-Gaviño; J Delgado-Cuesta; M Rincón-Gómez; L Giménez-Miranda; M D Navarro-Amuedo; M M Muñoz-García; S Calzón-Fernández; M Ollero-Baturone Journal: Arch Gerontol Geriatr Date: 2020-08-25 Impact factor: 4.163