PT - JOURNAL ARTICLE AU - Tiago Abreu AU - Telma Lopes AU - Marisa Anciães AU - Dalila Ferreira AU - Sara Salgado AU - Gil Duarte TI - Comparison of four systems for assessing severity of community acquired pneumonia DP - 2011 Sep 01 TA - European Respiratory Journal PG - p2488 VI - 38 IP - Suppl 55 4099 - http://erj.ersjournals.com/content/38/Suppl_55/p2488.short 4100 - http://erj.ersjournals.com/content/38/Suppl_55/p2488.full SO - Eur Respir J2011 Sep 01; 38 AB - Introduction: The use of severity scores for community acquired pneumonia (CAP) is recommended by many clinical guidelines. However, debate about the preferred system is ongoing.Objective: To compare the performance of 4 systems to identify severe CAP.Material and methods: We reviewed 176 patients diagnosed with CAP, admitted in a Pneumology ward, from January 2007 to July 2009. We compared 4 systems: Pneumonia Severity Index (PSI), CURB65, modified American Thoracic Society criteria for severe pneumonia (ATSm) and SCAP score.We divided the patients in 2 groups: low/intermediate risk and high risk, the later defined as CURB65 ≥3, PSI classes IV/V, ATSm – ≥1 major criteria or ≥ 3 minor criteria and SCAP score – ≥1 major criteria or ≥ 2 minor criteria.We evaluated the performance of these systems in predicting patient adverse outcomes, defined as mortality and need for ICU admission, based on sensitivity, specificity and area under the ROC curve (AUC).Results: Sensitivity and specificity (95% confidence interval in brackets) were, respectively: CURB65 – 27.3% [9.7 - 56.6] and 91.5% [86.3 - 94.9]. PSI – 81.8% [52.3 - 94.9] and 55.8% [48.1 - 63.1]. ATSm – 54.6% [28.0 – 78.7] and 95.8% [91.5 - 97.9]. SCAP – 81.8% [52.3 - 94.9] and 70.9% [63.6 - 71.3].AUC was: CURB65 – 0.594, PSI – 0.688, ATSm – 0.752 and SCAP – 0.764.Conclusions: PSI and SCAP were the most sensitive systems, while CURB65 and ATSm were the most specific. Although the best discriminative capacity was found in SCAP, it presented many false positives. Probably, a good approach would be to rely on clinical judgment, triage of high risk patients with PSI or SCAP and use of ATSm to determine need for ICU admission.