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    Patent Pending

    PSI/PORT Score: Pneumonia Severity Index for CAP

    Estimates mortality for adult patients with community-acquired pneumonia.
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    When to Use
    Pearls/Pitfalls
    Why Use

    The PSI/PORT Score can be used in the clinic or emergency department setting to risk stratify a patient’s community acquired pneumonia.

    • Since points are assigned by absolute age in the PSI, it may underestimate severe pneumonia in an otherwise young healthy patient.
    • Consider sepsis in patients with pneumonia; the PSI was developed prior to aggressive sepsis screening with lactate testing.
    • Though a patient may be categorized as appropriate for outpatient treatment, assess potential barriers to treatment such as vomiting, alcohol/drug use, psychosocial conditions, or cognitive impairments.
    • Any patient over 50 years of age is automatically classified as risk class 2, even if they otherwise are completely healthy and have no other risk criteria.

    The PSI/PORT Score is a useful tool which provides an excellent risk stratification of community acquired pneumonia. For most patients however, the CURB-65 is easier to use and requires fewer inputs.

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    Next Steps
    Evidence
    Creator Insights

    Advice

    While many pneumonias are actually viral in nature, typical practice is to provide a course of antibiotics given the pneumonia may be bacterial.

    Disposition (inpatient vs. outpatient) often dictates further care and management -- including lab testing, blood cultures, etc.

    Management

    Step 1:

    • If the patient is >50 years of age, assign to risk class II - V and proceed to step 2.
    • If the patient is <50 years of age, but has a history of neoplastic disease, congestive heart failure, cerebrovascular disease, renal disease or liver disease, assign to risk class II - V and proceed to step 2.
    • If the patient has an altered mental status, pulse ≥ 125/minute, respiratory rate ≥ 30/minute, systolic blood pressure ≤ 90 mm Hg, or temperature < 35° C or ≥ 40° C, assign to risk class II - V and proceed to step 2
    • If none of the above apply, assign to risk class I = low risk.

    Step 2:

    • Assign points based on age, gender, nursing home residence, co-morbid illness, physical examination findings, and laboratory and radiographic findings as listed above.
    • Point distribution:
    ScoreRiskDisposition
    ≤70Low riskOutpatient care
    71-90Low riskOutpatient vs. Observation admission
    91-130Moderate riskInpatient admission
    >130High riskInpatient admission

    Critical Actions

    For patients scoring high on PSI, it would be prudent to ensure initial triage has not missed the presence of sepsis. Evaluation of SIRS criteria would be beneficial.

    Formula

    Addition of selected points, as above.

    Facts & Figures

    Score interpretation:

    Risk ClassRiskPoint Value
    ILowNone from Comorbidities, PE findings, or Lab findings
    IILow≤70 points
    IIILow71-90
    IVModerate91-130
    VHigh>130 total points

    Evidence Appraisal

    The original study created a five-tier risk stratification based on 14199 inpatients with community acquired pneumonia. This was then validated on 38039 inpatients and additionally another 2287 inpatients and outpatients. Points are assigned based on age, co-morbid disease, abnormal physical findings, and abnormal laboratory results.

    In comparison to the PSI score, CURB-65 offers equal sensitivity of mortality prediction due to community acquired pneumonia. Notably, CURB-65 (74.6%) has a higher specificity than PSI (52.2%). However, CURB-65 had a lower sensitivity than PSI in predicting ICU admission.

    Dr. Michael J. Fine

    About the Creator

    Michael J. Fine, MD, MSc, is a professor in the Division of General Internal Medicine at the University of Pittsburgh. He is also the director of the Center for Health Equity Research and Promotion (CHERP) at the VA Pittsburgh Healthcare System. Dr. Fine’s research focuses on improving healthcare equity for patients with common medical conditions, such as community-acquired pneumonia, venous thromboembolism, and diabetes, especially in vulnerable patient populations.

    To view Dr. Michael J. Fine's publications, visit PubMed

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