Improving Discrimination in Predicting Level of Care Needed for Patients Admitted with Pneumonia
David E Katz1,2, Gideon Leibner3, Nechama Kaufman4,5
1Department of Internal Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. dekatz1@gmail.com.
Background:
Various risk stratification scores are used to predict outcomes among patients with pneumonia. We have developed a novel model that predicts the risk of death or intensive care unit transfer in internal medicine.
Objective:
To compare the ability of two prediction models to predict clinical outcomes in patients admitted for pneumonia, using information available at the time of admission.
Design:
Comparison of two prediction models.
Participants:
3856 pneumonia admissions to the internal medicine service of a tertiary medical center.
Main Measures:
We compared the ability of two scores to predict in-hospital mortality and escalation of care (e.g., to the intensive care unit) among patients admitted for pneumonia. One was the CURB-65 score, which is currently in use at our hospital. The other score was one we developed, based on the Elixhauser case mix adjustment model with additional data, such as vital signs and laboratory values.
Key Results:
11.8% of patients died in-hospital and 17.7% required an escalation of care. The most common CURB-65 score was 2 (44%), the lowest CURB-65 score ordinarily requiring admission. Our risk prediction score was better than CURB-65 at predicting mortality (c-statistic 0.846 vs. 0.724) and escalation (0.757 vs. 0.633). Our score was able to discriminate among patients classified as similar-risk by the CURB-65 score: of the 1681 patients with a (medium-risk) CURB-65 score of 2, our model placed 180 (11%) into the lowest-risk quintile of patients, and 309 (18%) into the highest-risk quintile.
Conclusions:
Our risk stratification tool is calculable with information available in the electronic medical record of most hospitals. The new score was much better able to predict the outcomes of in-hospital mortality and escalation of care among patients admitted for pneumonia, compared to CURB-65.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:10Documentation of Nursing Diagnosis
In some settings, data-driven computerized decision support systems are in place, allowing for more accurate nursing diagnoses. The database within one of these systems includes diagnostic labels defining characteristics, activities, and indicators for nursing. A nurse enters...