Assessment of illness severity in community acquired pneumonia: a useful new prediction tool?
Routine clinical judgement was found to underestimate illness severity in one study 6 and another found illness severity assessment to be the most common failing in the management of young adults dying from CAP. 7 Severity assessment before ICU admission has been found to be suboptimal for a wide va...
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Veröffentlicht in: | Thorax 2003-05, Vol.58 (5), p.371-372 |
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Sprache: | eng |
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Zusammenfassung: | Routine clinical judgement was found to underestimate illness severity in one study 6 and another found illness severity assessment to be the most common failing in the management of young adults dying from CAP. 7 Severity assessment before ICU admission has been found to be suboptimal for a wide variety of conditions, 8 and the variation in hospital 9- 13 and ICU 14 admission rates for CAP is probably at least in part due to inaccurate severity assessment. Based on the modified "BTS rule", a CURB (Confusion, blood Urea >7 mmol/l, Respiratory rate >=30/min, and low Blood pressure) severity score was calculated. There is some evidence that a severity based approach can reduce primarily cost related outcomes (such as length of hospital stay) which may be of qualitative value to the patient. 20- 23 However, other studies have not found reductions in length of stay 24 or the potential to treat more at home. 25, 26 Only one study has suggested a reduction in mortality. 27 Such studies are difficult to design and conduct, but the CAPITAL study shows what might be done. 21 In this site randomised study 10 hospitals using conventional practice were compared with nine others where a critical care pathway, including severity assessment with the PSI, was used. [...]changes produced comparable improvement in control and study hospitals in trials of care pathways for various surgical procedures. 28 The evidence that severity scoring tools can improve outcomes is largely based on North American healthcare systems which may or may not be translatable to other, especially primary care based, healthcare systems. |
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ISSN: | 0040-6376 1468-3296 |
DOI: | 10.1136/thorax.58.5.371 |