To describe the current understanding and clinical applicability of severity scoring systems in pneumonia management.
Severity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment. It is not clear that severity scores are helpful to guide empiric antibiotic treatment. The inclusion of biomarkers and performance status might improve the predictive performance of the well known severity scores in community-acquired pneumonia. We should improve our methods for score evaluation and move toward the development of decision-aid tools.
The application of the available evidence favors the use of severity scoring systems to improve the delivery of care for pneumonia patients. The incorporation of new methodologies and the formulation of different questions other than mortality prediction might help the further development of severity scoring systems, and enhance their support to the clinical decision-making process for the pneumonia-management cascade.
aDepartment of Pulmonology, Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Institut D’investigacions August Pi I Sunyer (IDIBAPS); Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
bPulmonary Division, Heart Institute (InCor)
cDisciplina de Emergências Clínicas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo
dHospital Sírio-Libanês, São Paulo, Brazil
Correspondence to Dr Antoni Torres, UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170 08036 Barcelona, Spain. Tel/. fax: +34 93 227 55 49; e-mail: ATORRES@clinic.cat