PT  - JOURNAL ARTICLE
AU  - Jihen Ben Halima
AU  - Wided Ben Ahmed
AU  - Leila El Gharbi
AU  - Besma Dhari
AU  - Saloua Azzabi
AU  - Mohamed Ali Baccar
AU  - Hichem Aouina
AU  - Hend Bouacha
TI  - Severity scores and management of community acquired pneumonia
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - P2725
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/P2725.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/P2725.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - Background: International guidelines recommend a severity-based approach to management in community-acquired pneumonia(CAP). CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended severity scores.The aim of this study was to compare the performance characteristics of these scores for predicting mortality in CAP.Methods: This retrospective study was carried on at Charles Nicolle hospital. 115 patients with an admission diagnosis of CAP were enrolled. Patients were stratified into 2 groups according to evolution: favorable (recovery after antibiotic therapy) or unfavorable (transfer to intensive care unit or deaths). Clinical and laboratory features at presentation were used to calculate severity scores using the PSI and BTS severity score (CRB65). We compared sensitivity, specificity, predictive values, likelihood ratios and the discriminatory power (area under the receiver operating characteristic curve) of these scores according to the evolution.Results: The age of patients ranged from 17 to 87 years with an average of 60 years (72% male). Sixty patients (52 %) had more than 65 years. 11 patients (9.5%) died or required intensive care transfer. PSI and CRB65 were the only factors independently correlated to unfavorable evolution. PSI≥ IV and CRB65≥2 had a high sensitivity but lower specificity for predicting a bad evolution. CRB65 was more sensitive (90.9%) than the PSI (72.7%). The area under the receiver operating characteristic curve was 0.79 for both the PSI and the CRB65 (p=0.002, for each pairwise comparison).Conclusions: Although, severity assessment tools are useful guides in the management of patients with CAP, clinical judgment must remain decisive.