Sharp Adam L, Jones Jason P, Wu Ivan, Huynh Dan, Kocher Keith E, Shah Nirav R, Gould Michael K
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Department of Emergency Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA.
Acad Emerg Med. 2016 Apr;23(4):400-5. doi: 10.1111/acem.12929. Epub 2016 Mar 24.
Pneumonia severity tools were primarily developed in cohorts of hospitalized patients, limiting their applicability to the emergency department (ED). We describe current community ED admission practices and examine the accuracy of the CURB-65 to predict 30-day mortality for patients, either discharged or admitted with community-acquired pneumonia (CAP).
A retrospective, observational study of adult CAP encounters in 14 community EDs within an integrated healthcare system. We calculated CURB-65 scores for all encounters and described the use of hospitalization, stratified by each score (0-5). We then used each score as a cutoff to calculate sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratios, and negative likelihood ratios for predicting 30-day mortality.
The sample included 21,183 ED encounters for CAP (7,952 discharged and 13,231 admitted). The C-statistic describing the accuracy of CURB-65 for predicting 30-day mortality in the full sample was 0.761 (95% confidence interval [CI], 0.747-0.774). The C-statistic was 0.864 (95% CI, 0.821-0.906) among patients discharged from the ED compared with 0.689 (95% CI, 0.672-0.705) among patients who were admitted. Among all ED encounters a CURB-65 threshold of ≥1 was 92.8% sensitive and 38.0% specific for predicting mortality, with a 99.9% NPV. Among all encounters, 62.5% were admitted, including 36.2% of those at lowest risk (CURB-65 = 0).
CURB-65 had very good accuracy for predicting 30-day mortality among patients discharged from the ED. This severity tool may help ED providers risk stratify patients to assist with disposition decisions and identify unwarranted variation in patient care.
肺炎严重程度评估工具主要是在住院患者队列中开发的，限制了其在急诊科（ED）的适用性。我们描述了当前社区急诊科的收治情况，并检验CURB-65评分预测社区获得性肺炎（CAP）患者出院或入院后30天死亡率的准确性。
对一个综合医疗系统内14个社区急诊科的成年CAP病例进行回顾性观察研究。我们计算了所有病例的CURB-65评分，并按每个评分（0 - 5）分层描述住院情况。然后我们将每个评分作为截断值，计算预测30天死亡率的敏感性、特异性、阳性预测值、阴性预测值（NPV）、阳性似然比和阴性似然比。
样本包括21183例急诊科CAP病例（7952例出院，13231例入院）。描述CURB-65评分预测全样本30天死亡率准确性的C统计量为0.761（95%置信区间[CI]，0.747 - 0.774）。急诊科出院患者的C统计量为0.864（95% CI，0.821 - 0.906），而入院患者的C统计量为0.689（95% CI，0.672 - 0.705）。在所有急诊科病例中，CURB-65评分≥1预测死亡率的敏感性为92.8%，特异性为38.0%，阴性预测值为99.9%。在所有病例中，62.5%的患者入院，其中包括36.2%风险最低（CURB-65 = 0）的患者。
CURB-65评分在预测急诊科出院患者30天死亡率方面具有很好的准确性。这种严重程度评估工具可能有助于急诊科医生对患者进行风险分层，以协助做出处置决策，并识别患者护理中不必要的差异。
