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.
- 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.
- 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:
|≤70||Low risk||Outpatient care|
|71-90||Low risk||Outpatient vs. Observation admission|
|91-130||Moderate risk||Inpatient admission|
|>130||High risk||Inpatient admission|
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.