Pneumonia

I. Definition
II. Etiology
III. Pathophysiology
IV. Diagnosis
V. Severity Index
Two sets of criteria are currently being used:

A.Pneumonia Severity Index (PSI)

score or Pneumonia Outcome
Research Team (PORT) score
B.CURB-65 criteria
A. Pneumonia Severity Index (PSI) score or Pneumonia Outcome
Research Team (PORT) score
 a prognostic model used to identify patients at low risk of dying
 has been used to decide whether patients with pneumonia can be
treated as outpatients or as (hospitalized) inpatients
 points are given for 20 variables, including age, coexisting illness, and
abnormal physical and laboratory findings.
 has two steps

Pneumonia Severity Index (PSI) score or Pneumonia Outcome

Research Team (PORT) score
 B. CURB-65 criteria
 a severity-of-illness score
 CURB-65 is an acronym for each of the risk factors measured. Each risk
factor scores one point, for a maximum score of 5:
o Confusion of new onset (defined as an AMT of 8 or less)
o Urea greater than 7 mmol/l (Blood Urea Nitrogen > 19)
o Respiratory rate of 30 breaths per minute or greater
o Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or
less
o age 65 or older
 is used as a means of deciding the action that is needed to be taken for
that patient.
o 0-1 treat as an outpatient
o 2 consider a short stay in hospital or watch very closely as an
outpatient
o 3-5 requires hospitalization with consideration as to whether they need
to be in the intensive care unit
 The risk of death increases as the score increases:
* 0—0.7%
* 1—3.2%
* 2—13.0%
* 3—17.0%
 * 4—41.5%
* 5—57.0%
AMT
The abbreviated mental test score (AMTS) was introduced by Hodkinson in
1972[1] to rapidly assess elderly patients for the possibility of dementia. Its
uses in medicine have become somewhat wider, e.g. to assess for confusion
and other cognitive impairment, although it has mainly been validated in the
elderly.

The following questions are put to the patient. Each question correctly
answered scores one point. A score of 6 or less suggests delirium or
dementia, although further and more formal tests are necessary to confirm
the diagnosis.

VI. Therapeutic Management

References:
http://content.nejm.org/cgi/content/full/336/4/243/F1
http://en.wikipedia.org/wiki/Abbreviated_mental_test_score
http://en.wikipedia.org/wiki/CURB-65
http://en.wikipedia.org/wiki/Pneumonia_severity_index
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765992/pdf/v056p00iv1.pdf
http://ourmedicine.blogspot.com/2010/01/186-pneumonia-severity-index-psi-
score.html