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Prognostic scoring systems: which one is best?

Feldman, Charles

Current Opinion in Infectious Diseases: April 2007 - Volume 20 - Issue 2 - p 165–169
doi: 10.1097/QCO.0b013e328014da75
Respiratory infections

Purpose of review In the initial evaluation of patients with community-acquired pneumonia, a number of important assessments are made, including that of the severity of the illness. This assessment will determine the appropriate site of care, diagnostic work-up, and choice of empiric antibiotics. A number of severity assessment tools have been developed and some of the recent findings are reviewed.

Recent findings A number of studies of the efficacy of the individual scoring systems, as well as comparator studies, have been undertaken. A significant number of patients with community-acquired pneumonia in Pneumonia Severity Index classes I and II are admitted to hospital and several of these patients suffer complications. Clinical and social factors other than those contained in the scoring systems need to be taken into consideration when deciding about hospitalization of patients with community-acquired pneumonia. A number of studies of the efficacy of the various scoring systems in predicting ‘severe pneumonia’ have been undertaken, as well as studies of their accuracy in the sub-set of patients with pneumococcal infections and in the elderly.

Summary The various scoring systems have reasonable sensitivity and specificity and their own strengths and weaknesses, but should always be used in association with good clinical judgment.

Division of Pulmonology, Department of Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa

Correspondence to Professor Charles Feldman, MB BCh, PhD, FRCP, FCP (SA), Professor of Pulmonology, Division of Pulmonology, Department of Medicine, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa Tel: +27 11 488 3840; fax: +27 11 488 4675; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.