Department of Respiratory Medicine, Mater Adult Hospital, Auchenflower, Queensland, Australia.
Respirology. 2013 Feb;18(2):291-6. doi: 10.1111/j.1440-1843.2012.02275.x.
The value of community-acquired pneumonia (CAP) severity scoring tools is almost exclusively reliant upon regular and accurate application in clinical practice. Until recently, the Australasian Therapeutic Guidelines has recommended the use of the Pneumonia Severity Index (PSI) in spite of poor user-friendliness.
Electronic and postal survey of respiratory and emergency medicine physician and specialist registrar members of the Royal Australasian College was undertaken to assess the use of the PSI and the accuracy of its application to hypothetical clinical CAP scenarios. The confusion, urea, respiratory rate, blood pressure, age 65 or older (CURB-65) score was also assessed as a simpler alternative.
Five hundred thirty-six (228 respiratory, 308 emergency) responses were received. Only 12% of respiratory and 35% of emergency physicians reported using the PSI always or frequently. The majority were unable to accurately approximate PSI scores, with significantly fewer respiratory than emergency physicians recording accurate severity classes (11.8% vs 21%, OR 0.50, 95% CI: 0.37-0.68, P < 0.0001). In contrast, significantly more respiratory physicians were able to accurately calculate the CURB-65 score (20.4% vs 15%, OR 1.45, 95% CI: 1.10-1.91, P = 0.006).
Australasian specialist physicians primarily responsible for the acute management of CAP report infrequent use of the PSI and are unable to accurately apply its use to hypothetical scenarios. Furthermore, respiratory and emergency physicians contrasted distinctly in their use and application of the two commonest severity scoring systems--the recent recommendation of two further alternative scoring tools by Australian guidelines may add to this confusion. A simple, coordinated approach to pneumonia severity assessment across specialties in Australasia is needed.
社区获得性肺炎（CAP）严重程度评分工具的价值几乎完全依赖于在临床实践中的定期和准确应用。直到最近，澳大利亚治疗指南仍推荐使用肺炎严重指数（PSI），尽管其用户友好性较差。
对皇家澳大利亚学院呼吸和急诊医学医师和专科住院医师进行了电子和邮寄调查，以评估 PSI 的使用情况及其在假设的 CAP 临床情况下的应用准确性。还评估了更简单的替代方案—— confusion，urea，respiratory rate，blood pressure，age 65 or older（CURB-65）评分。
共收到 536 份（228 份呼吸，308 份急诊）回复。只有 12%的呼吸科医生和 35%的急诊医生报告经常或经常使用 PSI。大多数人无法准确估计 PSI 评分，记录准确严重程度类别的呼吸科医生明显少于急诊医生（11.8%对 21%，OR 0.50，95%CI：0.37-0.68，P<0.0001）。相比之下，更多的呼吸科医生能够准确计算 CURB-65 评分（20.4%对 15%，OR 1.45，95%CI：1.10-1.91，P=0.006）。
主要负责 CAP 急性管理的澳大利亚专科医生报告说很少使用 PSI，并且无法准确地将其应用于假设情况。此外，呼吸科和急诊医生在使用和应用两种最常见的严重程度评分系统方面存在明显差异——澳大利亚指南进一步推荐两种新的替代评分工具可能会增加这种混乱。澳大利亚亚专科之间需要采用一种简单、协调的肺炎严重程度评估方法。
