Respiratory Care: Chest Infections |

Validation of the Modified CRB-65 Pneumonia Severity Index as a Prognostic Tool FREE TO VIEW

Georges Al-Helou, MD; Dana Kay, MD; Jalil Ahari, MD; Linda Lesky, MD
Author and Funding Information

George Washington University, Washington, DC

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1243A. doi:10.1016/j.chest.2016.08.1355
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SESSION TITLE: Chest Infections

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Community Acquired Pneumonia (CAP) is a leading cause of hospitalizations not just in the United States but also around the world. It can range in severity from a mild disease treated as outpatient to a severe, life-threatening condition. Several prognostication scores have been identified and used to determine disease severity and mortality risk. The CRB-65 score was introduced as a simple score to determine mortality without the need for laboratory testing; however, it tended to over-estimate mortality. The modified CRB-65 scoring system was published in 2014 by Dwyer et al. to increase sensitivity of the CRB-65 score by adding oxygen saturation less than 90% and presence of co-morbid conditions. This modification has not been validated yet and we aim to test if this system would be useful in other patient populations

METHODS: After IRB approval, we searched our electronic database for all patients who were seen for CAP in our emergency department and internal medicine clinics. A total of 6048 patient charts with ICD-9 and ICD-10 codes for pneumonia were identified. Of these, 748 patients were identified as CAP and were included in the study. Confusion, respiratory rate above 30, systolic blood pressure below 90 or diastolic below 60, oxygen saturation below 90% and the presence of co-morbid conditions were used to calculate the score. The 30 day mortality was used as a primary outcome. We calculated the area under the Receiver Operating Characteristic (ROC) curve and the C-statistic of the new test to measure its utility.

RESULTS: The area under the Receiver Operating Characteristic (ROC) curve for the proposed system was 0.91 with a sensitivity of 96% and a specificity of 73%. A score of 1 or less had a mortality of 0.13%. Respiratory rate more than 30 was the variable with the strongest association with mortality (up to 28 time higher mortality). Also, the CRB-65 score had an area under the ROC curve of 0.923 but a sensitivity of 85% and a specificity of 85%.

CONCLUSIONS: By adding the oxygen saturation and co-morbid diseases, the sensitivity of the scoring index was increased while remaining independent of laboratory testing. As such, this score is a better predictor of mortality and has a better negative predictive value as compared to the CRB-65.

CLINICAL IMPLICATIONS: The modifications introduced can help lower the number of hospitalizations by improving the sensitivity of the CRB-65 and increase the negative predictive value as compared to the CRB-65. By using a score of less than 2 as a cut-off, it would be safe to treat patients in an outpatient setting and decrease hospital admissions, and susequently, health care costs

DISCLOSURE: The following authors have nothing to disclose: Georges Al-Helou, Dana Kay, Jalil Ahari, Linda Lesky

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