Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia - 17/09/11
, Julio Ramirez b, Roberto Cosentini c, Anna Maria Brambilla c, Anna Maria Zanaboni d, Valeria Rossetti e, Paolo Tarsia e, Paula Peyrani b, Federico Piffer e, Francesco Blasi e
Corresponding author. Tel.: +39 0392339284, +39 3394171538(mobile); fax: +39 0392339437.Summary |
Background |
The relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.
Methods |
An observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.
Results |
Among the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.
Conclusions |
Although the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment.
Le texte complet de cet article est disponible en PDF.Keywords : Community-acquired pneumonia, CURB-65 score, Site-of-care, Cardiovascular events, Hypoxemia, Hospitalization
Abbreviations : AMI, ATS, BTS, CAP, COPD, CPAP, CURB-65, ER, FiO2, LOS, N, NIV, PaCO2, PaO2, PSI, SAPS, SD, USA
Plan
 | The work was presented at the 2008 European Respiratory Society Annual Conference. |
Vol 105 - N° 11
P. 1732-1738 - novembre 2011 Retour au numéro
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