Pflug M A, Wesemann T, Heppner H J, Thiem U
Klinik für Altersmedizin und Frührehabilitation, Marienhospital Herne, Ruhr-Universität Bochum, Bochum, Deutschland.
Klinik für Geriatrie, HELIOS Klinikum Schwelm, Private Universität Witten/Herdecke, Witten/Herdecke, Deutschland.
Z Gerontol Geriatr. 2015 Oct;48(7):608-13. doi: 10.1007/s00391-015-0896-x. Epub 2015 May 9.
Community-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.
For epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.
Since the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.
At present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.
For treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.
社区获得性肺炎（CAP）对于老年患者而言仍然是一种重要且严重的疾病。
出于流行病学和临床原因，整理CAP不同严重程度的发生率，并获取关于CAP对不同风险群体的传播情况及威胁程度的信息非常重要。在门诊治疗中，一个易于执行的预后评分可用于客观评估患者的临床状况并支持治疗决策。为此，潜在用户应了解合适的工具。
自20世纪90年代以来，已开发并评估了多种用于CAP分层的风险评分。本文介绍了现有风险评分的内容和价值，同时对各个评分的优缺点进行了批判性比较。特别强调了风险评分对老年患者的重要性。
目前，关于门诊或住院治疗的决策主要基于CRB - 65风险评分。重症监护病房收治标准由美国胸科学会（ATS）修订标准提供。总体而言，风险评分对老年患者的可靠性低于年轻成年人。
对于老年患者的治疗决策，除了本文讨论的风险评分方面外，还应考虑功能方面。特别是，对于老年CAP患者的住院决策应在考虑利弊关系的基础上，根据个体情况做出。
