Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia |
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Authors: | Aliberti Stefano Ramirez Julio Cosentini Roberto Brambilla Anna Maria Zanaboni Anna Maria Rossetti Valeria Tarsia Paolo Peyrani Paula Piffer Federico Blasi Francesco |
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Affiliation: | aDipartimento di Medicina Clinica e Prevenzione, University of Milan-Bicocca, Clinica pneumologica, AO San Gerardo, Via Pergolesi 33, 20052 Monza, Italy;bDivision of Infectious Diseases, Department of Internal Medicine, University of Louisville, Louisville, 40202 KY, USA;cEmergency Medicine Department, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy;dComputer Science Department, University of Milan, Via Comelico 39, 20135 Milan, Italy;eDipartimento toraco-polmonare e cardio-circolatorio, University of Milan, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy |
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Abstract: | BackgroundThe relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.MethodsAn observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.ResultsAmong the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.ConclusionsAlthough the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment. |
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Keywords: | Community-acquired pneumonia CURB-65 score Site-of-care Cardiovascular events Hypoxemia Hospitalization |
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