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The Pneumonia Severity Index (PSI) stratifies pneumonia patients by risk for short-term mortality. Those in risk classes I to III have a mortality rate <1% and are considered low-risk. Although extensively validated, the PSI is not routinely used in all emergency departments (EDs), particularly outside North America.
In a prospective, observational, controlled study conducted at 16 EDs in France, researchers assessed the effectiveness and safety of using the PSI to guide site-of-treatment decisions for patients with community-acquired pneumonia (CAP) who present to the ED. Eight of the EDs had already begun to use the PSI to manage CAP cases (PSI-user EDs), and eight had not (PSI-nonuser EDs). (The PSI scores used in the analysis were calculated by the investigators, regardless of the PSI-user status of the ED.) Outcomes were assessed 28 days after presentation.
A total of 925 patients were enrolled. For patients classified as low-risk, 43% evaluated by PSI-user EDs were managed as outpatients, compared with 24% evaluated by PSI-nonuser EDs (P<0.01). No deaths occurred among the 148 low-risk patients treated as outpatients, versus 7 among the 301 treated as inpatients. Overall, after adjustment for PSI risk class, the 28-day mortality rate was significantly lower in the PSI-user ED group than in the PSI-nonuser ED group.
Renaud B et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: A multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007 Jan 1; 44:41-9.
Comment
These results add to the findings of several other studies demonstrating that PSI use can lead to more efficient management of patients with CAP. In particular, they indicate that patients categorized as low-risk (categories I–III) can be safely managed as outpatients. Based on this, the PSI should be used at the point-of-contact for all patients with CAP.