PSI

# Criteria

1. General
1. Age in years: ADD 1 point per year
2. Gender: SUBTRACT 10 points for women
3. Nursing home resident: ADD 10 points
2. Past medical history
1. Cancer: ADD 30 points
2. Liver Disease: ADD 20 points
3. CHF: ADD 10 points
4. CVA: ADD 10 points
5. Chronic Kidney Disease: ADD 10 points
3. Examination findings
1. Altered Level of Consciousness: ADD 20 points
2. Breathing Rate >30 rpm: ADD 20 points
3. Systolic BP <90>125 bpm: ADD 10 points
4. Labs: Arterial Blood Gas (ABG)
1. Arterial pH <7.35:>64 mg/dl: ADD 20 points
3. Serum Glucose >250 mg/dl: ADD 10 points
6. Labs: Blood Count
1. Hematocrit <30%:>130: Mortality 29.2% (high risk)

# Interpretation

1. Class 1-2: Outpatient management
2. Class 3: Consider short observation hospital stay
3. Class 4-5: Inpatient management

The purpose of the PSI is to classify the severity of a patient's pneumonia to determine the amount of resources to be allocated for care. Most commonly, the PSI scoring system has been used to decide whether patients with pneumonia can be treated as outpatients or as (hospitalized) inpatients. A Risk Class I pneumonia patient can be sent home on oral antibiotics. A Risk Class II-III pneumonia patient may be sent home with IV antibiotics or treated and monitored for 24 hours in hospital. Patients with Risk Class IV-V pneumonia patient should be hospitalized for treatment.

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CURB-65

CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site. The CURB-65 is based on the earlier CURB score and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.

The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:

* Confusion of new onset (defined as an AMT of 8 or less)
* Urea greater than 7 mmol/l (Blood Urea Nitrogen > 19)
* Respiratory rate of 30 breaths per minute or greater
* Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less
* age 65 or older



The risk of death increases as the score increases:

* 0—0.7%
* 1—3.2%
* 2—13.0%
* 3—17.0%
* 4—41.5%
* 5—57.0%

The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia.

It is used as a means of deciding the action that is needed to be taken for that patient. 0-1 treat as an outpatient 2 consider a short stay in hospital or watch very closely as an outpatient 3-5 requires hospitalization with consideration as to whether they need to be in the intensive care unit
[edit] Any infection

A cohort study of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases:

* 0 to 1 <5% mortality
* 2 to 3 < 10% mortality
* 4 to 5 15-30% mortality

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