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    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Patent Pending

    RAPID Score for Pleural Infection

    Predicts mortality in patients with pleural infection.

    INSTRUCTIONS

    Use in patients with confirmed pleural infection.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patient with pleural infection, defined by the presence of at least one of the following:

    • Purulent fluid.
    • Positive bacterial culture in fluid.
    • Positive result for bacteria on Gram staining in fluid.
    • Fluid pH <7.2, measured using a blood gas analyzer.
    • Based on trials done in the UK only, so extrapolation to different populations may not be accurate.
    • Although technically externally validated by MIST2, this was not the intended purpose of the study. A large prospective validation study for RAPID is underway.
    • Although the score seems to be able to reliably stratify patients into low, moderate and high risk categories, there is no clear indication for changing treatment exists yet.
    • Purulence confers decreased mortality, which is counter to some other studies. The authors observed that purulent collections were less likely to have loculations and were therefore more amenable to complete drainage.
    • Pleural infection is a common condition with a high mortality with rising incidence in both adult and pediatric populations.
    • Treatment options vary from very invasive, such as thoracic surgery, to simple treatment with antibiotics and/or intrapleural fibrinolytics.
    • Determining which therapeutic approach is best for each patient can be challenging, as can predicting which patients are most likely to need extended stays in hospital.
    • The RAPID Score is a robustly-developed risk model which has the potential to allow treatments to be more effectively targeted in pleural infection patients.
    <14 mg/dL (5 mmol/L)
    0
    14–23 mg/dL (5–8 mmol/L)
    +1
    >23 mg/dL (8 mmol/L)
    +2
    <50
    0
    50-70
    +1
    >70
    +2
    Yes
    0
    No
    +1
    Community-acquired
    0
    Hospital-acquired
    +1
    ≥2.7 g/dL (27 g/L)
    0
    <2.7 g/dL (27 g/L)
    +1

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Najib M. Rahman

    About the Creator

    Najib M. Rahman, BM BCh, PhD, is a consultant and senior lecturer in respiratory medicine in the Nuffield Department of Medicine in Oxford, United Kingdom. His research interests are in pleural infection and pleural malignancy. Dr. Rahman leads pleural trials and trials methodology at the Oxford Respiratory Trials Unit (ORTU).

    To view Dr. Najib M. Rahman's publications, visit PubMed

    Are you Dr. Najib M. Rahman? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Rahul Bhatnagar, MBChB
    About the Creator
    Dr. Najib M. Rahman
    Are you Dr. Najib M. Rahman?
    Content Contributors
    • Rahul Bhatnagar, MBChB