SESSION TYPE: Pneumonia Morbidity and Mortality
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: BACKGROUND Moderate to severe community acquired pneumonia (CAP) is a leading cause of mortality in the country today. Monitoring this risk group of patients requires a structured but accurate method of prognosticating adverse outcomes. OBJECTIVE To determine the validity and accuracy of the systolic BP, oxygenation, age and respiratory rate (SOAR) scoring system in predicting 30-day all cause mortality and hospital re-admission in moderate to high risk CAP.
METHODS: A total of 119 admitted adult patients with moderate to severe CAP as defined by the recent local guidelines prospectively evaluated using the SOAR index. We excluded patients with hospital acquired pneumonia and immune compromised condition. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, area under the curve (AUC) were calculated together with their 95% confidence intervals
RESULTS: The mortality rate in high risk CAP was 29%, none for the moderate risk group. The SOAR criteria predicted 30-day all-cause mortality with an overall accuracy of 88.6% (Area Under the Curve, 95% CI 92-95.2, Std Error=.034, p<.001), The cut-off score of ≥ 2 yields an overall sensitivity of 94.1% (95% CI 71.3-99.9%) and specificity of 73.5% (95% CI 63.9 -81.8%). Systolic BP and respiratory rate had the highest sensitivity and specificity values. (SBP of < 90 mmHg Sn=88.2, Sp=87.2; Respiratory rate of ≥ 30 Sn=88.2, Sp=67.5). The scoring system showed fair accuracy (68.4%) in predicting hospital readmission. (Area Under the Curve, 95% CI 52-85, Std Error=.084, p=.28)
CONCLUSIONS: The SOAR is a simple and rapid tool of prognosticating moderate to high risk community acquired pneumonia.
CLINICAL IMPLICATIONS: It can be utilized without invasive laboratory tests and can be performed by trained health care personnel. KEY WORDS: S.O.A.R scoring system, community acquired pneumonia, validity, accuracy
DISCLOSURE: The following authors have nothing to disclose: Sangit Kasaju, Richie Acuzar, Mark Ramirez, Abner Koh, Shirley Panganiban
No Product/Research Disclosure InformationChinese General Hospital and Medical Center, Manila, Philippines