Neill A M, Martin I R, Weir R, Anderson R, Chereshsky A, Epton M J, Jackson R, Schousboe M, Frampton C, Hutton S, Chambers S T, Town G I
Canterbury Respiratory Research Group, Christchurch School of Medicine, New Zealand.
Thorax. 1996 Oct;51(10):1010-6. doi: 10.1136/thx.51.10.1010.
Community acquired pneumonia remains an important cause of hospital admission and carries an appreciable mortality. Criteria for the assessment of severity during admission have been developed by the British Thoracic Society (BTS). A study was performed to determine the sensitivity and specificity of a severity rule based on a modification of the BTS prognostic rules applied on admission, to compare severity as assessed by medical staff with the modified rule, and to determine the microbiological cause of community acquired pneumonia in Christchurch.
A 12 month study of all adults admitted to Christchurch Hospital with community acquired pneumonia was undertaken. Three hundred and sixteen consecutive patients with suspected community acquired pneumonia were screened for inclusion. Variables obtained from the history, examination, investigations, and initial treatment were examined for association with mortality.
Two hundred and fifty five patients met the inclusion criteria. Their mean age was 58 years (range 18-97). A microbiological diagnosis was made in 181 cases (71%), Streptococcus pneumonia (39%), Mycoplasma pneumoniae (16%), Legionella species (11%), and Haemophilus influenzae (11%) being the most commonly identified organisms. Patients had a 36-fold increased risk of death if any two of the following were present on admission: respiratory rate > or = 30/min, diastolic BP < or = 60 mm Hg, urea > 7 mmol/l, or confusion. The severity rule identified 19 of the 20 patients who died and six of eight patients admitted to the intensive care unit as having life threatening community acquired pneumonia. The sensitivity of the modified rule for predicting death was 0.95 and the specificity 0.71. In 47 cases (21%) the clinical team appeared to underestimate the severity of the illness.
The organisms responsible for community acquired pneumonia in Christchurch are similar to those reported from other centres except for Legionella species which were more common than in most studies. The modification of the BTS prognostic rules applied as a severity indicator at admission performed well and could be incorporated into management guidelines.
社区获得性肺炎仍然是住院的重要原因，且死亡率可观。英国胸科学会（BTS）已制定了入院时严重程度评估标准。开展了一项研究，以确定基于对入院时应用的BTS预后规则进行修改的严重程度规则的敏感性和特异性，比较医务人员评估的严重程度与修改后的规则，并确定克赖斯特彻奇社区获得性肺炎的微生物病因。
对所有因社区获得性肺炎入住克赖斯特彻奇医院的成年人进行了为期12个月的研究。对316例连续疑似社区获得性肺炎的患者进行筛选以纳入研究。检查从病史、检查、调查和初始治疗中获得的变量与死亡率的相关性。
255例患者符合纳入标准。他们的平均年龄为58岁（范围18 - 97岁）。181例（71%）做出了微生物学诊断，最常鉴定出的病原体为肺炎链球菌（39%）、肺炎支原体（16%）、军团菌属（11%）和流感嗜血杆菌（11%）。如果入院时出现以下任何两项情况，患者死亡风险增加36倍：呼吸频率≥30次/分钟、舒张压≤60 mmHg、尿素>7 mmol/L或意识模糊。严重程度规则识别出20例死亡患者中的19例以及8例入住重症监护病房的患者中的6例患有危及生命的社区获得性肺炎。修改后的规则预测死亡的敏感性为0.95，特异性为0.71。在47例（21%）病例中，临床团队似乎低估了疾病的严重程度。
除军团菌属比大多数研究更常见外，克赖斯特彻奇社区获得性肺炎的病原体与其他中心报告的相似。作为入院时严重程度指标应用的BTS预后规则的修改表现良好，可纳入管理指南。
