RT Journal Article
SR Electronic
T1 Validity of CRB-65 in LRTI in primary care: A prospective study in 12 European countries
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p2479
VO 38
IS Suppl 55
A1 Samuel Coenen
A1 Theo Verheij
A1 Greet Ieven
A1 Christine Lammens
A1 Christopher Butler
A1 Paul Little
A1 Herman Goossens
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p2479.abstract
AB Background: CRB-65, a useful tool to predict community-acquired pneumonia (CAP) outcome in hospitals, has been recommended for use in primary care. CRB-65 scores are calculated by assigning one point for each of: the presence of Confusion, Respiratory rate ≥ 30 per minute, Blood pressure systolic < 90 mm Hg or diastolic ≤ 60 mm Hg, and age ≥ 65 years.Aim: To assess the validity of CRB-65 to predict poor prognosis in adults presenting to primary care with lower respiratory tract infection (LRTI).Methods: Clinicians prospectively recorded clinical features on a case registration form. Patients had a chest X-ray within 7 days after inclusion. A notes review was performed. We used a two-level logistic regression model (with patients nested within clinicians) to assess the association between a CRB-65 score ≥ 1 and mortality and a combination of re-consultation and hospital admission, and tested for interaction to assess differences in these outcome between patients with and those without CAP.Results: None of the 3112 included patients died due to the LRTI. Complete data were available in 2627 (84%) patients. Of these, 866 (33%) had a CRB-65 score ≥ 1, 108 (4%) had CAP, and 488 (19%) re-consulted or were admitted to hospital. Both a CRB-65 score ≥ 1 and CAP were associated with more re-consultations or hospital admissions (odds ratio (95%CI): 1.32 (1.06–1.64) and 2.18 (1.13–4.21), respectively). The interaction term was not significant (1.17 (0.57-2.41)).Conclusion: In patients presenting to primary care with LRTI, low mortality and low prevalence of CAP limit the usefulness of CRB-65. Nevertheless, a CRB-65 score ≥ 1 is associated with a significant increase in re-consultations and hospital admissions.