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What Is the Prognosis for Using the Pneumonia Severity Index To Make Site-of-Care Decisions In Community-Acquired Pneumonia?

Michael S. Niederman
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Affiliations: Mineola, NY
 ,  Dr. Niederman is Chairman, Department of Medicine, Winthrop-University Hospital, and Professor of Medicine, Vice-Chairman, Department of Medicine, State University of New York at Stony Brook.

Correspondence to: Michael S. Niederman, MD, FCCP, Winthrop-University Hospital, Department of Medicine, 222 Station Plaza N, Suite 509, Mineola, NY 11501; e-mail: mniederman@winthrop.org



Chest. 2003;124(6):2051-2053. doi:10.1378/chest.124.6.2051
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Starting in 1993, the approach to community-acquired pneumonia (CAP) changed dramatically with the development of management guidelines by a number of national societies.12 This process has continued for a decade, and the result has been a more organized approach to disease management and to defining the agenda for research in CAP. Although guidelines help to provide a framework for the care of patients, there are a number of controversies in management, and not all guidelines have approached these issues in the same way. One unresolved issue is deciding who should be admitted to the hospital, a decision that has a major impact on the cost of care for patients with CAP. The American Thoracic Society guidelines have stated that the admission decision is an “art-of-medicine” decision and that scoring systems, such as the pneumonia severity index (PSI), should be used as decision support tools for evaluating mortality risk.1 But, they also have stated that no rule can be used, by itself, to define the need for hospitalization.1 On the other hand, the Infectious Disease Society of America has endorsed the use of the PSI to guide the admission decision.2

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