Pneumonia severity index (Port Score)
Use
- Estimates mortality for adult patients with community-acquired pneumonia
Scoring
Pneumonia severity index (Port Score)
Risk Factors |
Points |
Demographic Factors | |
Age for men |
Age |
Age for women |
Age -10 |
Nursing home resident |
+10 |
Coexisting Illnesses |
|
Neoplastic disease (active) |
+30 |
Chronic liver disease |
+20 |
Heart Failure |
+10 |
Cerebrovascular disease |
+10 |
Chronic renal disease |
+10 |
Physical Exam |
|
AMS |
+20 |
RR > 30/min |
+20 |
Sys BP < 90 |
+20 |
Temp <35 or >40 |
+15 |
Pulse > 125 |
+10 |
Lab and xray findings |
|
Arterial pH < 7.35 |
+30 |
BUN > 30 |
+20 |
Na <130 |
+20 |
Glucose > 250 |
+10 |
Hematocrit <30% |
+10 |
PaO2 < 60 or SpO2 < 90% |
+10 |
Pleural effusion |
+10 |
Classification
Class |
Points |
Mortality |
I |
<51 | 0.1% |
II |
51-70 | 0.6% |
III |
71-90 |
0.9% |
IV |
91-130 |
9.3% |
V |
>130 |
27% |
Disposition Pathway
- Classes I and II: consider discharge
- Class III: discharge verus admit based on clinical judgment
- Classes IV and V: consider admission
CURB-65
- Confusion
- bUn > 19 mg/dl
- RR > 30
- BP < 90 SBP, or < 60 DBP
- Age > 65
- Approximate 30-day mortalities and Tx considerations
- +1 --> 3%, outpt tx
- +2 -->7%, inpt, possible outpt
- +3 --> 14% inpt, possible ICU
- +4-5 --> 30% ICU
Prognosis
- Half of patients are still symptomatic at 30 days, with a significant minority of patients experiencing chest pain, malaise or mild dyspnea even 2 to 3 months after treatment
- In adults with CAP whose symptoms have resolved within 5-7 days, it is not recommended to routinely obtain follow-up chest imaging