[Usefulness of the CRB-65 scale for prognosis assessment of patients 65 years or older with community-acquired pneumonia].
OBJECTIVE
The assessment of severity may be important to decide hospitalisation and type of treatment in community-acquired pneumonia (CAP) cases. This study evaluated the ability of the severity rule CRB-65 for the management of older adults with CAP.


METHODS
Population-based study including 473 patients 65 years or older with a radiographically confirmed CAP in the region of Tarragona (Spain). Treatment setting and clinical variables were considered for each patient, CRB-65 score (confusion, respiratory rate>or=30, systolic blood pressure<90 mmHg or diastolic<or=60 mmHg, age>or=65 years) was calculated at the time of diagnosis, and 30-day mortality was considered as a main dependent variable.


RESULTS
Overall mortality rate was 12.7% (15.5% among hospitalised and 1.7% in outpatient cases). Mortality was directly associated with the CRB-65 score, being 6.8% in score 1 (2.4% among patients 65-74 years and 10.1% in patients 75 years or older; P=.005), 26.1% in score 2, 41.7% in score 3 and 66.7% in score 4. For a breakpoint of CRB-65 score>or=2, sensitivity was 60% (95% CI: 42-78) and specificity was 80% (95% CI: 76-84).


CONCLUSIONS
The CRB-65 has an acceptable ability to classify mortality risk in elderly patients with CAP. Patients with CRB-65=1 have a relatively small mortality rate, which suggests that they could be managed as outpatients.
Vila Córcoles
Angel
A
Servicio de Atención Primaria de Tarragona-Valls, Dirección de Atención Primaria Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain.
Ochoa Gondar
Olga
O
Rodríguez Blanco
Teresa
T
D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis*; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index