Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia

View larger version (18K): [in a new window]   Figure 1. Revised pneumonia probabilities based on history and physical examination findings. The effects of history and physical examination findings separately and in combination were examined in the ambulatory care setting, where the baseline prevalence of community-acquired pneumonia is 5%. Likelihood ratios derived from Table 1 were applied to the baseline prevalence by using the Bayes theorem (post-test odds = pretest odds x likelihood ratio). The range of revised probabilities depicted by the width of each bar reflects the range of likelihood ratios observed for these findings. The finding of normal vital signs requires heart rate of 100 beats/min or less, temperature of 37.8 °C or less, and respiratory rate of 20 breaths/min or less (19).

View larger version (36K): [in a new window]   Figure 2. Application of the Pneumonia Patient Outcomes Research Team Severity Index to determine initial site of treatment. Step 1 identifies patients in risk class I on the basis of age 50 years or younger and the absence of all comorbid conditions and vital sign abnormalities listed in step 2. For all patients who are not classified as risk class I, the laboratory data listed in step 2 should be collected to calculate a pneumonia severity score. Risk class and recommended site of care based on the pneumonia severity score are listed in the final table. Thirty-day mortality data are based on two independent cohorts of 40 326 patients. For additional information, see reference 97. BP = blood pressure; BUN = blood urea nitrogen.