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PSI/PORT Score: Pneumonia Severity Index for CAP

Estimates mortality for adult patients with community-acquired pneumonia.

years

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.

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