Development and validation of a clinical prediction rule for severe community-acquired pneumonia

Am J Respir Crit Care Med. 2006 Dec 1;174(11):1249-56. doi: 10.1164/rccm.200602-177OC. Epub 2006 Sep 14.


Rationale: Objective strategies are needed to improve the diagnosis of severe community-acquired pneumonia in the emergency department setting.

Objectives: To develop and validate a clinical prediction rule for identifying patients with severe community-acquired pneumonia, comparing it with other prognostic rules.

Methods: Data collected from clinical information and physical examination of 1,057 patients visiting the emergency department of a hospital were used to derive a clinical prediction rule, which was then validated in two different populations: 719 patients from the same center and 1,121 patients from four other hospitals.

Measurements and main results: In the multivariate analyses, eight independent predictive factors were correlated with severe community-acquired pneumonia: arterial pH < 7.30, systolic blood pressure < 90 mm Hg, respiratory rate > 30 breaths/min, altered mental status, blood urea nitrogen > 30 mg/dl, oxygen arterial pressure < 54 mm Hg or ratio of arterial oxygen tension to fraction of inspired oxygen < 250 mm Hg, age > or = 80 yr, and multilobar/bilateral lung affectation. From the beta parameter obtained in the multivariate model, a score was assigned to each predictive variable. The model shows an area under the curve of 0.92. This rule proved better at identifying patients evolving toward severe community-acquired pneumonia than either the modified American Thoracic Society rule, the British Thoracic Society's CURB-65, or the Pneumonia Severity Index.

Conclusions: A simple score using clinical data available at the time of the emergency department visit provides a practical diagnostic decision aid, and predicts the development of severe community-acquired pneumonia.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Community-Acquired Infections / diagnosis
  • Comorbidity
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia / diagnosis*
  • Pneumonia / epidemiology
  • Predictive Value of Tests
  • Prognosis