title: Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Severity assessment and site-of-care decisions for patients with community-acquired pneumonia (CAP) are pivotal for patients' safety and adequate allocation of resources. Late admission to the intensive care unit (ICU) has been associated with increased mortality in CAP. We aimed to review and meta-analyze systematically the performance of clinical prediction rules to identify CAP patients requiring ICU admission or intensive treatment.
  
  
  METHODS
  We systematically searched Medline, Embase, and the Cochrane Controlled Trials registry for clinical trials evaluating the performance of prognostic rules to predict the need for ICU admission, intensive treatment, or the occurrence of early mortality in patients with CAP.
  
  
  RESULTS
  Sufficient data were available to perform a meta-analysis on eight scores: PSI, CURB-65, CRB-65, CURB, ATS 2001, ATS/IDSA 2007, SCAP score, and SMART-COP. The estimated AUC of PSI and CURB-65 scores to predict ICU admission was 0.69. Among scores proposed for prediction of ICU admission, ATS-2001 and ATS/IDSA 2007 scores had better operative characteristics, with a sensitivity of 70% (CI, 61 to 77) and 84% (48 to 97) and a specificity of 90% (CI, 82 to 95) and 78% (46 to 93), but their clinical utility is limited by the use of major criteria.
  
  
  CONCLUSIONS
  New severity scores for predicting the need for ICU or intensive treatment in patients with CAP, such as ATS/IDSA 2007 minor criteria, SCAP score, and SMART-COP, have better discriminative performances compared with PSI and CURB-65. High negative predictive value is the most consistent finding among the different prediction rules. These rules should be considered an aid to clinical judgment to guide ICU admission in CAP patients.
authors: Christophe
authors: C
authors: Marti
authors: Nicolas
authors: N
authors: Garin
authors: Olivier
authors: O
authors: Grosgurin
authors: Antoine
authors: A
authors: Poncet
authors: Christophe
authors: C
authors: Combescure
authors: Sebastian
authors: S
authors: Carballo
authors: Arnaud
authors: A
authors: Perrier
mesh_terms: D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index