[Where to manage community acquired pneumonia? The assessment of severity].

The assessment of severity. Severity assessment is a key element in the management of community-acquired pneumonia. This assessment will determine the level of diagnostic workup and treatment, as well as the site of care. Several tools have been developed to help this assessment. The Pneumonia Severity Index (PSI) or the CURB-65 can accurately identify patients with a low risk of death who might be considered for outpatient care while those with a high risk of death would be hospitalized. Nevertheless, PSI and CURB-65 are less accurate for identifying patients requiring admission to an intensive care unit (ICU). Different scores, such the American Thoracic Society criteria or the SMART-COP score, were built to predict need for admission to ICU, vasopressors or mechanical ventilation. Each score has its own strengths and weaknesses and physicians must be aware of these limitations. Although, severity assessment tools are useful guides in the management of patients with community acquired pneumonia, clinical judgment must remain decisive.