Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts

Phyo K Myint, Ajay V Kamath, Sarah L Vowler, David N Maisey, Brian D W Harrison, British Thoracic Society

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Abstract

OBJECTIVES: To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients.

DESIGN: Compilation study of two prospective observational cohorts.

SETTING AND PARTICIPANTS: A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP.

MAIN OUTCOME MEASURE: All-cause mortality occurring within the 6 week follow-up.

RESULTS: sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria.

CONCLUSIONS: Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.

Original languageEnglish
Pages (from-to)286-291
Number of pages6
JournalAge and Ageing
Volume35
Issue number3
DOIs
Publication statusPublished - May 2006

Fingerprint

Respiratory Rate
Pneumonia
Prospective Studies
Blood Pressure
Sensitivity and Specificity
Mortality
Ventilation
Urea
Perfusion
Odds Ratio
Outcome Assessment (Health Care)
Guidelines
Population

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aging
  • Blood Pressure
  • Cohort Studies
  • Community-Acquired Infections
  • Female
  • Great Britain
  • Humans
  • Male
  • Middle Aged
  • Oxygen
  • Pneumonia
  • Respiration
  • Sensitivity and Specificity

Cite this

@article{008b1b08a6f74fea85fa1cfcad6ec669,
title = "Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people?: A compilation study of two prospective cohorts",
abstract = "OBJECTIVES: To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients.DESIGN: Compilation study of two prospective observational cohorts.SETTING AND PARTICIPANTS: A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP.MAIN OUTCOME MEASURE: All-cause mortality occurring within the 6 week follow-up.RESULTS: sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0{\%} (58.1-94.6), 59.3{\%} (49.6-68.4), 27.0{\%} (16.6-39.7) and 94.4{\%} (86.2-98.4), respectively, confirming their comparability with existing criteria.CONCLUSIONS: Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Aging, Blood Pressure, Cohort Studies, Community-Acquired Infections, Female, Great Britain, Humans, Male, Middle Aged, Oxygen, Pneumonia, Respiration, Sensitivity and Specificity",
author = "Myint, {Phyo K} and Kamath, {Ajay V} and Vowler, {Sarah L} and Maisey, {David N} and Harrison, {Brian D W} and {British Thoracic Society}",
year = "2006",
month = "5",
doi = "10.1093/ageing/afj081",
language = "English",
volume = "35",
pages = "286--291",
journal = "Age and Ageing",
issn = "0002-0729",
publisher = "OXFORD UNIV PRESS INC",
number = "3",

}

TY - JOUR

T1 - Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people?

T2 - A compilation study of two prospective cohorts

AU - Myint, Phyo K

AU - Kamath, Ajay V

AU - Vowler, Sarah L

AU - Maisey, David N

AU - Harrison, Brian D W

AU - British Thoracic Society

PY - 2006/5

Y1 - 2006/5

N2 - OBJECTIVES: To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients.DESIGN: Compilation study of two prospective observational cohorts.SETTING AND PARTICIPANTS: A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP.MAIN OUTCOME MEASURE: All-cause mortality occurring within the 6 week follow-up.RESULTS: sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria.CONCLUSIONS: Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.

AB - OBJECTIVES: To assess the usefulness of the British Thoracic Society guidelines for severity assessment of community-acquired pneumonia (CAP) in predicting mortality and to explore alternative criteria which could be more useful in older patients.DESIGN: Compilation study of two prospective observational cohorts.SETTING AND PARTICIPANTS: A University hospital in Norfolk, UK with a catchment population of 568,000. Subjects were 195 patients (median age = 77 years) who were included in two prospective studies of CAP.MAIN OUTCOME MEASURE: All-cause mortality occurring within the 6 week follow-up.RESULTS: sensitivity, specificity, positive and negative predictive values for study outcome using CURB and CURB-65 were assessed in 189 patients, and CRB-65 in 192 patients out of a total of 195 patients. Our results were comparable with the original study by Lim et al. Although CURB-65 and CRB-65 included age criteria, in effect they did not materially improve the specificity in predicting high-risk patients in both studies. We found that oxygenation measured by ventilation perfusion mismatch (PaO2:FiO2) was the best predictor of outcome in this slightly older cohort [odds ratio (OR) = 0.99 (0.98-0.99), P = 0.0001]. We derived a new set of criteria; SOAR (systolic blood pressure, oxygenation, age and respiratory rate) based on our findings. Their sensitivity, specificity, positive and negative predictive values were 81.0% (58.1-94.6), 59.3% (49.6-68.4), 27.0% (16.6-39.7) and 94.4% (86.2-98.4), respectively, confirming their comparability with existing criteria.CONCLUSIONS: Our Study confirms the usefulness of currently recommended severity rules for CAP in this older cohort. SOAR criteria may be useful as alternative criteria for a better identification of severe CAP in advanced age where both raised urea level above 7 mmol/l and confusion are common.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Aging

KW - Blood Pressure

KW - Cohort Studies

KW - Community-Acquired Infections

KW - Female

KW - Great Britain

KW - Humans

KW - Male

KW - Middle Aged

KW - Oxygen

KW - Pneumonia

KW - Respiration

KW - Sensitivity and Specificity

U2 - 10.1093/ageing/afj081

DO - 10.1093/ageing/afj081

M3 - Article

C2 - 16638769

VL - 35

SP - 286

EP - 291

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 3

ER -