Thursday, April 16, 2009

pneumonia severity index (PSI)

Pneumonia Severity Index (PSI)


What is it?
A prediction rule to calculate the severity of a person with community acquired pneumonia (CAP). It is based on data that are commonly available upon presentation and divide patients into 5 different classes, according to the severity of the disease. Higher scores mean higher risk of death, admission to ICU and longer length of stay in the hospital. The patient may need to be treated as an inpatient.

How to use it?


The index is based on several criteria such as demographic factors, signs and symptoms as well as lab and radiographic findings. In the index, each different characteristic are assigned different points. Patient with the characteristic will add the points with the patient’s age (-10 for women). Eventually, all the points will be added up and the patient will be classified into 5 different classes, according to the points.



The index is as below, and the classes are included in the diagram.




What happen to the patient in the classes?


Patients in risk classes 1, 2 and 3 are regarded as at low risk of death and are mostly treated as outpatients unless there are other risk factors. The low risk patients in class 3 who look sick or needed further care can stay in the hospital for another 23 hours and monitored for deterioration. After the patient’s condition is better, patient will be allowed to leave the hospital.



As for patients grouped in class 4 (moderate risk) and 5 (high risk), they should be hospitalized due to their higher risks of death and complications.



There is an exception for patients with hypoxemia or PaO2 of >60mm Hg. These patients must be hospitalized regardless of their PSI score. This also applies to patients with metastatic disease (endocarditis, meningitis, osteomyelitis) or those infected with high risk pathogens such as Staph. aureus.

Hasif.

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