Kabundji Dalton Mulombe, Musekiwa Alfred, Mukansi Murimisi, Feldman Charles
Helen Joseph Hospital and Division of Emergency Medicine, Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2014 Oct 24;104(11):769-772. doi: 10.7196/samj.8150.
The CRB-65 severity of illness score, used for assessing patients with community-acquired pneumonia (CAP), may be of particular benefit in resource-constrained areas, since it relies purely on clinical parameters.
To assess the potential accuracy of the CRB-65 score when used in deciding whether to hospitalise patients with CAP presenting to an emergency department (ED).
Prospective, observational study in an academic hospital in Johannesburg, South Africa. Data from adult patients with radiologically confirmed CAP were analysed.
Overall, 152 patients were enrolled (79 females, 73 males; median age 36.5 years). Several diverse criteria had been used by the ED doctors in admission decisions, while the CRB-65 score had been used in only 3/152 patients (1.6%). Overall, 68/152 patients (44.7%) had been managed as inpatients and 84/152 (55.3%) as outpatients. If the CRB-65 had been used as the sole criterion for site-of-care decisions, 107/152 patients (70.4%) would potentially have been managed as outpatients and 45/152 (29.6%) as inpatients. Achieving a stable clinical condition took longer (p=0.037) and mortality was higher (p<0.001) in patients with higher than lower CRB-65 scores. All five patients who died were inpatients. Of these, three (60.0%) would have been classified by the CRB-65 as having an intermediate mortality risk and two (40.0%) as having a high mortality risk.
This study demonstrates the utility of the CRB-65 score in accurately determining the need for admission of patients with CAP presenting to an ED in a resource-constrained environment.
用于评估社区获得性肺炎（CAP）患者的CRB - 65疾病严重程度评分，可能在资源有限的地区特别有用，因为它完全依赖于临床参数。
评估CRB - 65评分在决定急诊科（ED）就诊的CAP患者是否住院时的潜在准确性。
在南非约翰内斯堡的一家学术医院进行前瞻性观察研究。分析了放射学确诊为CAP的成年患者的数据。
总体上，共纳入152例患者（79例女性，73例男性；中位年龄36.5岁）。急诊科医生在入院决策中使用了多种不同的标准，而CRB - 65评分仅在3/152例患者（1.6%）中使用。总体而言，68/152例患者（44.7%）接受了住院治疗，84/152例（55.3%）接受了门诊治疗。如果将CRB - 65作为护理地点决策的唯一标准，107/152例患者（70.4%）可能会接受门诊治疗，45/152例（29.6%）接受住院治疗。CRB - 65评分较高的患者达到稳定临床状态所需时间更长（p = 0.037），死亡率更高（p < 0.001）。所有5例死亡患者均为住院患者。其中，3例（60.0%）根据CRB - 65评分被归类为中度死亡风险，2例（40.0%）为高度死亡风险。
本研究证明了CRB - 65评分在准确确定资源有限环境下急诊科就诊的CAP患者是否需要住院方面的实用性。
