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Thorax. 1996 Oct;51(10):1010-6.
Community acquired pneumonia: aetiology
and usefulness of severity criteria on admission.
Neill AM, Martin IR, Weir R, Anderson R,
Chereshsky A, Epton MJ, Jackson R, Schousboe M, Frampton C,
Hutton S, Chambers ST, Town GI.
Canterbury Respiratory Research Group, Christchurch School of
Medicine, New Zealand.
BACKGROUND: Community acquired pneumonia
remains an important cause of hospital admission and carries an
appreciable mortality. Criteria for the assessment of severity
during admission have been developed by the British Thoracic
Society (BTS). A study was performed to determine the
sensitivity and specificity of a severity rule based on a
modification of the BTS prognostic rules applied on admission,
to compare severity as assessed by medical staff with the
modified rule, and to determine the microbiological cause of
community acquired pneumonia in Christchurch. METHODS: A 12
month study of all adults admitted to Christchurch Hospital with
community acquired pneumonia was undertaken. Three hundred and
sixteen consecutive patients with suspected community acquired
pneumonia were screened for inclusion. Variables obtained from
the history, examination, investigations, and initial treatment
were examined for association with mortality. RESULTS: Two
hundred and fifty five patients met the inclusion criteria.
Their mean age was 58 years (range 18-97). A microbiological
diagnosis was made in 181 cases (71%), Streptococcus pneumonia
(39%), Mycoplasma pneumoniae (16%), Legionella species (11%),
and Haemophilus influenzae (11%) being the most commonly
identified organisms. Patients had a 36-fold increased risk of
death if any two of the following were present on admission:
respiratory rate > or = 30/min, diastolic BP < or = 60 mm
Hg, urea > 7 mmol/l, or confusion. The severity rule
identified 19 of the 20 patients who died and six of eight
patients admitted to the intensive care unit as having life
threatening community acquired pneumonia. The sensitivity of the
modified rule for predicting death was 0.95 and the specificity
0.71. In 47 cases (21%) the clinical team appeared to
underestimate the severity of the illness. CONCLUSIONS: The
organisms responsible for community acquired pneumonia in
Christchurch are similar to those reported from other centres
except for Legionella species which were more common than in
most studies. The modification of the BTS prognostic rules
applied as a severity indicator at admission performed well and
could be incorporated into management guidelines.
PMID: 8977602 [PubMed - indexed for
MEDLINE]
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