Department of Emergency Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Wien Klin Wochenschr. 2023 Oct;135(19-20):507-516. doi: 10.1007/s00508-023-02238-9. Epub 2023 Jul 5.
Community-acquired pneumonia (CAP) is a frequent reason for emergency department (ED) presentations. Various risk scores have been validated in the management of CAP and are recommended for daily practice.
The aim of the study was to evaluate the performance of the rapid risk scores (the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the Worthing physiological scoring system (WPS), CURB-65 and CRB-65) among patients with CAP.
This retrospective cohort study was conducted in the ED of a tertiary hospital between 1 January 2019 and 31 December 2019. Patients aged ≥ 18 years and diagnosed with CAP were included. Patients who were transferred from another center or with missing records were excluded. Demographic information, vital signs, level of consciousness, laboratory results, and outcomes were recorded.
A total of 2057 patients were included in the final analysis. The 30-day mortality of the patients was 15.2% (n = 312). The WPS achieved the most successful results for all three outcomes, 30-day mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) needs (area under the curve, AUC 0.810, 0.918, and 0.910, respectively; p < 0.001). In the prediction of mortality, RAPS, REMS, CURB-65, and CRB-65 had a moderate overall performance (AUC 0.648, 0.752, 0.778, and 0.739, respectively). In the prediction of ICU admission and MV needs, RAPS, REMS, CURB-65, and CRB-65 had moderate to good overall performance (AUC at ICU admission 0.793, 0.873, 0.829, and 0.810; AUC for MV needs 0.759, 0.892, 0.754, and 0.738, respectively). Advanced age, lower levels of mean arterial pressure and peripheral oxygen saturation, presence of active malignancy and cerebrovascular disease, and ICU admission were associated with mortality (p < 0.05).
The WPS outperformed other risk scores in patients with CAP and can be used safely. The CRB-65 can be used to discriminate critically ill patients with CAP due to its high specificity. The overall performances of the scores were satisfactory for all three outcomes.
社区获得性肺炎（CAP）是急诊科（ED）就诊的常见原因。各种风险评分已在 CAP 的管理中得到验证，并被推荐用于日常实践。
本研究旨在评估快速风险评分（快速急性生理学评分（RAPS）、快速急诊医学评分（REMS）、沃辛生理评分系统（WPS）、CURB-65 和 CRB-65）在 CAP 患者中的表现。
这是一项回顾性队列研究，在 2019 年 1 月 1 日至 12 月 31 日期间在一家三级医院的 ED 进行。纳入年龄≥18 岁且诊断为 CAP 的患者。排除从其他中心转来或记录缺失的患者。记录患者的人口统计学信息、生命体征、意识水平、实验室结果和结局。
共有 2057 名患者纳入最终分析。患者 30 天死亡率为 15.2%（n=312）。在所有三种结局（30 天死亡率、入住重症监护病房（ICU）和机械通气（MV）需求）中，WPS 的结果最成功，曲线下面积（AUC）分别为 0.810、0.918 和 0.910（p<0.001）。在死亡率预测方面，RAPS、REMS、CURB-65 和 CRB-65 的整体表现为中度（AUC 分别为 0.648、0.752、0.778 和 0.739）。在 ICU 入住和 MV 需求的预测中，RAPS、REMS、CURB-65 和 CRB-65 的整体表现为中度至良好（ICU 入住的 AUC 分别为 0.793、0.873、0.829 和 0.810；MV 需求的 AUC 分别为 0.759、0.892、0.754 和 0.738）。高龄、平均动脉压和外周血氧饱和度较低、活动性恶性肿瘤和脑血管疾病、入住 ICU 与死亡率相关（p<0.05）。
WPS 在 CAP 患者中的表现优于其他风险评分，可安全使用。CRB-65 由于其高特异性，可用于鉴别因 CAP 而病重的患者。评分的总体表现对于所有三种结局均令人满意。
