title: The usefulness of confusion, urea, respiratory rate, and shock index or adjusted shock index criteria in predicting combined mortality and/or ICU admission compared to CURB-65 in community-acquired pneumonia.
abstract: OBJECTIVE
  The study aims to assess the usefulness of age-independent criteria CURSI and temperature adjusted CURSI (CURASI) compared to CURB-65 in predicting community-acquired pneumonia (CAP) mortality. The criteria, CRSI and CRASI, were adapted for use in primary care and compared to CRB-65.
  
  
  METHODS
  A retrospective analysis of a prospectively identified cohort of community-acquired pneumonia inpatients was conducted. Outcomes were (1) mortality and (2) mortality and/or ICU admission within six weeks.
  
  
  RESULTS
  95 patients (median age = 61 years) were included. All three criteria had similar sensitivity in predicting mortality alone, with CURB-65 having slightly higher specificity. When predicting mortality and/or intensive care admission, CURSI/CURASI showed higher sensitivity and slightly lower specificity. CRSI and CRASI had higher sensitivity and lower specificity when compared with CRB-65 for predicting both primary and secondary outcomes. Results for both analyses had P values >0.05.
  
  
  CONCLUSIONS
  In a cohort of younger patients CURSI and adjusted CURSI perform at least as well as CURB-65, with a similar trend for CRSI and adjusted CRSI compared to CRB-65. Further studies are needed in different age groups and in primary and secondary care settings.
authors.affiliation: Addenbrooke's University Hospital, Cambridge, Cambridgeshire CB2 0QQ, UK ; School of Medicine & Dentistry, Division of Applied Health Sciences, C/o Room 4013, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
authors.forename: James P
authors.initials: JP
authors.lastname: Curtain
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sankaran
authors.forename: Ajay V
authors.initials: AV
authors.lastname: Kamath
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality*; D003221:Confusion / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D056152:Respiratory Rate; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014508:Urea / Q000378:metabolism
chemical_list: D014508:Urea
references.citation: Clin Med (Lond). 2003 Jan-Feb;3(1):54-6
references.pmid: 12617416
references.citation: Eur Respir J. 1997 Jul;10(7):1530-4
references.pmid: 9230242
references.citation: Thorax. 2000 Mar;55(3):219-23
references.pmid: 10679541
references.citation: Emerg Med Australas. 2007 Oct;19(5):418-26
references.pmid: 17919214
references.citation: QJM. 2009 Jun;102(6):379-88
references.pmid: 19299247
references.citation: Respiration. 2009;77(4):468-9
references.pmid: 19246885
references.citation: Arch Intern Med. 1997 Jul 14;157(13):1453-9
references.pmid: 9224224
references.citation: Thorax. 2008 Aug;63(8):698-702
references.pmid: 18492742
references.citation: Eur Respir J. 2006 Jan;27(1):151-7
references.pmid: 16387948
references.citation: Eur J Intern Med. 2010 Oct;21(5):429-33
references.pmid: 20816599
references.citation: Thorax. 2001 Dec;56 Suppl 4:IV1-64
references.pmid: 11713364
references.citation: Int J Clin Pract. 2009 Sep;63(9):1345-50
references.pmid: 19691619
references.citation: Br J Gen Pract. 2010 Oct;60(579):e423-33
references.pmid: 20883616
references.citation: Age Ageing. 2006 May;35(3):286-91
references.pmid: 16638769
references.citation: Crit Care. 2006;10 Suppl 2:S1
references.pmid: 16934135
references.citation: J Intern Med. 2006 Jul;260(1):93-101
references.pmid: 16789984
references.citation: Age Ageing. 2005 Jan;34(1):75-7
references.pmid: 15591485
references.citation: J Antimicrob Chemother. 2008 May;61(5):976-94
references.pmid: 18339633
references.citation: Thorax. 2003 May;58(5):377-82
references.pmid: 12728155
references.citation: Respirology. 2009 Mar;14(2):210-6
references.pmid: 19272082
references.citation: Thorax. 2010 Oct;65(10):884-90
references.pmid: 20729235
references.citation: Clin Microbiol Infect. 2009 Sep;15(9):858-64
references.pmid: 19702590
references.citation: Eur J Clin Microbiol Infect Dis. 2001 Jan;20(1):14-9
references.pmid: 11245317
references.citation: Respirology. 2001 Dec;6(4):323-30
references.pmid: 11844124