The Pneumonia Severity Index - Flowchart
The Pneumonia Severity Index - Flowchart Pneumonia, Bacterial Pneumonia, Bacterial
«Flowchart»

Patient with community-acquired pneumonia

Patient with community-acquired pneumonia

Patient with community-acquired pneumonia

CharacteristicAssigned points
Age


Male

Age (in years)


Female

Age (in years) – 10
Nursing home resident+10
Comorbidities


Malignant disease

+30


Liver disease

+20


Congestive heart failure

+10


Cerebrovascular disease

+10


Renal disease

+10
Altered mental status+20
Respiratory rate >30/min+20
Pulse >125+10
Systolic blood pressure <90 mm Hg+20
Temperature <35° C or >40° C+15
Arterial pH <7.35+30
Blood urea nitrogen >30 mg/dL+20
Sodium <130 mmol/liter+20
Glucose >250 mg/dL+10
Hematocrit <30%+10
PO2 <60 mm Hg or O2 saturation <90%+10
Pleural effusion+10
CharacteristicAssigned points
Age


Male

Age (in years)


Female

Age (in years) – 10
Nursing home resident+10
Comorbidities


Malignant disease

+30


Liver disease

+20


Congestive heart failure

+10


Cerebrovascular disease

+10


Renal disease

+10
Altered mental status+20
Respiratory rate >30/min+20
Pulse >125+10
Systolic blood pressure <90 mm Hg+20
Temperature <35° C or >40° C+15
Arterial pH <7.35+30
Blood urea nitrogen >30 mg/dL+20
Sodium <130 mmol/liter+20
Glucose >250 mg/dL+10
Hematocrit <30%+10
PO2 <60 mm Hg or O2 saturation <90%+10
Pleural effusion+10
CharacteristicAssigned points
Age


Male

Age (in years)


Female

Age (in years) – 10
Nursing home resident+10
Comorbidities


Malignant disease

+30


Liver disease

+20


Congestive heart failure

+10


Cerebrovascular disease

+10


Renal disease

+10
Altered mental status+20
Respiratory rate >30/min+20
Pulse >125+10
Systolic blood pressure <90 mm Hg+20
Temperature <35° C or >40° C+15
Arterial pH <7.35+30
Blood urea nitrogen >30 mg/dL+20
Sodium <130 mmol/liter+20
Glucose >250 mg/dL+10
Hematocrit <30%+10
PO2 <60 mm Hg or O2 saturation <90%+10
Pleural effusion+10
CharacteristicAssigned points Characteristic Assigned points Age Age


Male

Age (in years)


Male


Male


Male Age (in years)


Female

Age (in years) – 10


Female


Female


Female Age (in years) – 10 Nursing home resident+10 Nursing home resident +10 Comorbidities Comorbidities


Malignant disease

+30


Malignant disease


Malignant disease


Malignant disease +30


Liver disease

+20


Liver disease


Liver disease


Liver disease +20


Congestive heart failure

+10


Congestive heart failure


Congestive heart failure


Congestive heart failure +10


Cerebrovascular disease

+10


Cerebrovascular disease


Cerebrovascular disease


Cerebrovascular disease +10


Renal disease

+10


Renal disease


Renal disease


Renal disease +10 Altered mental status+20 Altered mental status +20 Respiratory rate >30/min+20 Respiratory rate >30/min +20 Pulse >125+10 Pulse >125 +10 Systolic blood pressure <90 mm Hg+20 Systolic blood pressure <90 mm Hg +20 Temperature <35° C or >40° C+15 Temperature <35° C or >40° C +15 Arterial pH <7.35+30 Arterial pH <7.35 +30 Blood urea nitrogen >30 mg/dL+20 Blood urea nitrogen >30 mg/dL +20 Sodium <130 mmol/liter+20 Sodium <130 mmol/liter +20 Glucose >250 mg/dL+10 Glucose >250 mg/dL +10 Hematocrit <30%+10 Hematocrit <30% +10 PO2 <60 mm Hg or O2 saturation <90%+10 PO2 <60 mm Hg or O2 saturation <90% O 2 2 +10 Pleural effusion+10 Pleural effusion +10

Age >50?

Age >50?

Age >50?

Yes

Yes

Yes

No

No

No

End

End

End

History of the conditions listed below?


Malignant disease
Liver disease
Congestive heart failure
Cerebrovascular disease
Renal disease

History of the conditions listed below?


Malignant disease
Liver disease
Congestive heart failure
Cerebrovascular disease
Renal disease

History of the conditions listed below?


Malignant disease
Liver disease
Congestive heart failure
Cerebrovascular disease
Renal disease


Malignant disease
Liver disease
Congestive heart failure
Cerebrovascular disease
Renal disease

Yes

Yes

Yes

No

No

No

Assign patient to risk class I

Assign patient to risk class I

Assign patient to risk class I

Stratification of risk score

RiskRisk classScoreMortality
LowIBased on algorithm0.1%
LowII≤700.6%
LowIII71–900.9%
ModerateIV91–1309.3%
HighV>13027.0%

Stratification of risk score

RiskRisk classScoreMortality
LowIBased on algorithm0.1%
LowII≤700.6%
LowIII71–900.9%
ModerateIV91–1309.3%
HighV>13027.0%

Stratification of risk score

RiskRisk classScoreMortality
LowIBased on algorithm0.1%
LowII≤700.6%
LowIII71–900.9%
ModerateIV91–1309.3%
HighV>13027.0%
RiskRisk classScoreMortality Risk Risk class Score Mortality LowIBased on algorithm0.1% Low I Based on algorithm 0.1% LowII≤700.6% Low II ≤70 ≤ 0.6% LowIII71–900.9% Low III 71–90 0.9% ModerateIV91–1309.3% Moderate IV 91–130 9.3% HighV>13027.0% High V >130 27.0%

BP, Blood pressure; O2, oxygen; Po2, partial pressure of oxygen.

BP, Blood pressure; O2, oxygen; Po2, partial pressure of oxygen.

BP, Blood pressure; O2, oxygen; Po2, partial pressure of oxygen.

BP O2 2 Po2 2

Findings on examination as listed below?


Altered mental status
Respiratory rate >30/min
Pulse >125 beats/min
Systolic BP <90 mm Hg
Temperature <35° C or >40° C

Findings on examination as listed below?


Altered mental status
Respiratory rate >30/min
Pulse >125 beats/min
Systolic BP <90 mm Hg
Temperature <35° C or >40° C

Findings on examination as listed below?


Altered mental status
Respiratory rate >30/min
Pulse >125 beats/min
Systolic BP <90 mm Hg
Temperature <35° C or >40° C


Altered mental status
Respiratory rate >30/min
Pulse >125 beats/min
Systolic BP <90 mm Hg
Temperature <35° C or >40° C

Yes

Yes

Yes

No

No

No