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
1 Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
2 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
3 Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK
4 Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
5 Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK
Address correspondence to: P. K. Myint, Clinical Gerontology Unit, Level 2 F&G Block, Box-251, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK. Tel: (+44) 1223 217292; Fax: (+44) 1223 336928 Email: Pkyawmyint{at}aol.com
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: BTS guidelines, community-acquired pneumonia (CAP), mortality, older people, elderly
Received April 7, 2005; accepted in revised form February 13, 2006.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  U. Thiem, D. Niklaus, B. Sehlhoff, C. Stuckle, H. J. Heppner, H. G. Endres, and L. Pientka C-reactive protein, severity of pneumonia and mortality in elderly, hospitalised patients with community-acquired pneumonia Age Ageing, November 1, 2009; 38(6): 693 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W S Lim, S V Baudouin, R C George, A T Hill, C Jamieson, I Le Jeune, J T Macfarlane, R C Read, H J Roberts, M L Levy, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009 Thorax, October 1, 2009; 64(Suppl_3): iii1 - iii55. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Pilotto, F. Addante, L. Ferrucci, G. Leandro, G. D'Onofrio, M. Corritore, V. Niro, C. Scarcelli, B. Dallapiccola, and M. Franceschi The Multidimensional Prognostic Index Predicts Short- and Long-Term Mortality in Hospitalized Geriatric Patients With Pneumonia J Gerontol A Biol Sci Med Sci, August 1, 2009; 64A(8): 880 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J D Chalmers, A Singanayagam, and A T Hill Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia Thorax, August 1, 2008; 63(8): 698 - 702. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bont, E. Hak, A. W. Hoes, J. T. Macfarlane, and T. J. M. Verheij Predicting Death in Elderly Patients With Community-Acquired Pneumonia: A Prospective Validation Study Reevaluating the CRB-65 Severity Assessment Tool Arch Intern Med, July 14, 2008; 168(13): 1465 - 1468. [Full Text] [PDF]
|
|
|
|
|
|
P. K Myint, A. V Kamath, S. L Vowler, and B. D W Harrison Simple modification of CURB-65 better identifies patients including the elderly with severe CAP Thorax, November 1, 2007; 62(11): 1015 - 1016. [Full Text] [PDF]
|
|
|
|
|
|
W. S. Lim Severity assessment in community-acquired pneumonia: moving on Thorax, April 1, 2007; 62(4): 287 - 288. [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Huang and D. M. Yealy Decision Rules and Pneumonia: What Are We "Predicting," and for Whom? Am. J. Respir. Crit. Care Med., December 1, 2006; 174(11): 1169 - 1170. [Full Text] [PDF]
|
|