Do Not Use Pneumonia Scoring Systems to Guide ICU Admission Decisions

Are pneumonia severities scoring systems useful for guiding decisions about intensive care unit (ICU) admission in patients with community-acquired pneumonia (CAP)? Using data from 28 observational studies, researchers assessed the accuracy of five pneumonia severity scoring systems for predicting ICU admission. The number of CAP patients in each study ranged from 114 to 3675. Need for ICU admission was determined by the treating physician; ICU admission rates varied from 2.5% to 19.9%.

Pooled sensitivity, specificity, and diagnostic odds ratios for predicting ICU admission were as follows:

• Pneumonia Severity Index ≥IV: 74%, 48%, 2.86

• CURB65 score ≥3: 49%, 74%, 2.85

• CRB65 score ≥3: 42%, 85%, 5.72

• 2001 American Thoracic Society criteria: 67%, 85%…