Risk Stratification for Community-Acquired Pneumonia (the Pneumonia Severity Index)
Factor | Points | ||
|---|---|---|---|
Patient demographics | |||
| Age (in years) | ||
| Age (in years) − 10 | ||
Nursing home resident | 10 | ||
Coexisting illness | |||
Cancer | 30 | ||
Liver disease | 20 | ||
Heart failure | 10 | ||
Cerebrovascular disease | 10 | ||
Renal disease | 10 | ||
Physical examination | |||
Altered mental status | 20 | ||
Respiratory rate ≥ 30 breaths/minute | 20 | ||
Systolic blood pressure < 90 mm Hg | 20 | ||
Temperature ≥ 40° C or < 35°C | 15 | ||
Heart rate ≥ 125 beats/minute | 10 | ||
Test results | |||
Arterial pH < 7.35 | 30 | ||
Blood urea nitrogen ≥ 30 mg/dL (11 mmol/L) | 20 | ||
Sodium < 130 mEq/L (130 mmol/L) | 20 | ||
Glucose ≥ 250 mg/dL (14 mmol/L) | 10 | ||
Hematocrit < 30% | 10 | ||
PaO2< 60 mm Hg or Oxygen saturation < 90%* | 10 | ||
Pleural effusion | 10 | ||
Points | Mortality | Recommendation | |
≤70 | < 1% | Outpatient treatment† | |
71−90 | <5% | Outpatient treatment† | |
91−130 | 5−15% | Admit | |
>130 | >15% | Admit | |
* Many clinicians consider hypoxemia an absolute indication for admission. | |||
† Acute care admission, subacute care admission, observation period, home IV antibiotics, or home nursing visits should be considered for patients who are frail, isolated, or living in unstable environments. | |||
PaO2 = partial pressure of arterial oxygen. | |||
Adapted from Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336(4):243-250. doi:10.1056/NEJM199701233360402. | |||