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Comparison of PSI Scoring System with CURB-65 as an Marker of Sevearity in Comminity Acquired Pneumonia

B G Saroja, Assistant Professor, Department of TB and Chest Diseases, Sapthagiri Institute of Medical sciences and Research Center, Bengaluru, Karnataka 560090, India. , B G Saroja

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Indian Journal of Emergency Medicine 4(3):p 165-168, Jul-Sep, 2018. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.9

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Abstract

Introduction: Pneumonia is a commonly seen ailment in the department of general medicine and chest medicine. However with timely diagnosis and appropriate management the duration of morbidity and mortality rate can be reduced. Various grading systems are utilized to predict the mortality rate of pneumonia.

Objective: We aimed at analysing the utility of PSI score and CURB-65 in predicting the 30 day mortality rate in patients with community acquired pneumonia at our institute.

Materials and methods: A retrospective study was conducted at our institution in which the records of the patients who presented to the department of Chest and emergency medicine between January 2017 to December 2017 and diagnosed as community acquired pneumonia were retrieved reviewed. Clinical examination findings, radiological findings and the laboratory findings were recorded in the patient’s proforma. The PSI score and CURB-65 score were calculated and correlated with the patient’s clinical outcome.

Results: 175 patients were diagnosed as community acquired pneumonia (CAP) cases. Among them 85 patients were treated on OPD basis. The rest 90 patients were hospitalised for treatment. 22 patients were admitted to wards, and 68 patients were admitted to ICU. Of the total 90 hospitalised patients 27 patients were females and 63 patients were males. The patients were between 20 years to 70 years. Highest numbers of patients were seen in the age group of 50-59 years. The clinical outcome was defined as mortality among the hospitalised patients. The mortality rate in our study was 30% (27 patients). Considering class I, II, III of PSI score as low risk group and score 0 to 2 of CURB-65 as low risk group the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of PSI Score were 85%, 65%, 35%, 84% and 50% respectively. In comparison the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CURB-65 were 27%, 71%, 60%, 100% and 80% respectively.

Conclusion: We conclude from our study that PSI score is more sensitive than CURB-65 in warranting the ICU admissions whereas CURB- 65 is more specific in predicting 30 day mortality risk among the patients. The diagnostic accuracy of CURB-65 was higher in our study.
 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.9

Keywords

PSI Score; CURB-65; Mortality Rate; Sensitivity; Specificity; Diagnostic Accuracy.

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