Pneumonia Severity Index
Info
Age (years)
Gender Male Female
Nursing-home resident Yes No
~Co-existing illnesses
Neoplastic disease Present Not present
Liver disease Present Not present
Congestive heart failure Present Not present
Cerebrovascular disease Present Not present
Renal disease Present Not present
~Physical examination findings
Altered mental status Yes No
Respiratory rate >=30 breaths/min Yes No
Systolic blood pressure < 90 mm Hg Yes No
Temperature < 35°C (95°F) or >=40°C (104°F) Yes No
Pulse >= 125 beats/min Yes No
~Laboratory and radiographic findings (if study performed)
Arterial blood pH < 7.35 Yes No Test not performed
Blood urea nitrogen level >=30 mg/dL Yes No Test not performed
Sodium level < 130 mmol/L Yes No Test not performed
Glucose level >=250 mg/dL Yes No Test not performed
Hematocrit < 30% Yes No Test not performed
Partial pressure of arterial 0(2) < 60 mm Hg or 0(2) Sat < 90% Yes No Test not performed
Pleural effusion Yes No Test not performed
R e s u l t s
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~Co-existing illnesses
 
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~Physical examination findings
 
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~Laboratory and radiographic findings (if study performed)
 
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Class
 
Score
 
Mortality
 
Show Results
Info
Pneumonia Severity Index

The Pneumonia Severity Index (PSI) is one of 2 recommended scores for use with guidelines for Community Acquired Pneumonia (CAP) published in 2007 through the joint efforts of both the Infectious Diseases Society of America and the American Thoracic Society.

The PSI is based upon a large amount of data (14,000 and 38,000 hospitalized CAP patients). This score places patients into 5 mortality risk classes (I-V with I being lowest risk and V being highest).

The ability of the PSI to predict mortality has been confirmed in multiple subsequent studies and is felt to be a highly validated system.

2007 CAP Guidelines are indicating need for inpatient admission vs. outpatient treatment based upon:

  • Clinical judgement
  • Pneumonia Severity Index (PSI) OR CURB-65 Scoring (Both of which are present in this resource)
  • PSI scores
    • Risk groups I and 2 (<51 points and 51-70 points respectively) = Usually treated as outpatient
    • Risk group III (71-90 points) may require observation admission
    • Risk groups IV/V (90-130 and >130 points respectively) should be admitted
  • CURB-65 scores
    • 0-1 = Usually treated as outpatient
    • 2 = Admission to medical ward
    • >=3 = Usually ICU admission

Interpretation:

Risk Class Score Mortality*
Low I < 51 0.1%
Low II 51 - 70 0.6%
Low III 71 - 90 0.9%
Medium IV 90 - 130 9.5%
High V > 130 26.7%

From the PORT study validation cohort

Need for ICU Admission should be strongly considered if 1major criterion or >=3 minor criterion are present:

Major Criteria

  • Patient mechanically ventilated
  • Septic Shock present

Minor Criteria

  • Respiratory rate>30/min
  • Arterial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2)ratio-lt;250
  • Multilobar infiltrates
  • Confusion
  • BUN>20 mg/dL
  • Leukopenia (believed due to infection)
  • Thrombocytopenia
  • Hypothermia
  • Hypotension requiring aggressive fluid resuscitation

References:

Fine MJ, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.

The Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007;44 [Suppl 2]:S27-72.

Available online at: http://www.journals.uchicago.edu/CID/journal/issues/v44nS2/41620/41620.html