Seppa et al identified risk factors for identifying community acquired severe lower respiratory tract infection (LRTI) in elderly patients. This can help identify patients who may require more aggressive therapy. The authors are from Oulu University Hospital in Finland.
Patient population: Elderly patients with normal activities of daily living.
Exclusions: Patients on immunosuppressive medications, bedridden, with dementia or with terminal illness.
Parameters:
(1) exacerbation of concurrent illness
(2) respiratory rate
(3) C reactive protein (CRP) concentration
|
Parameter
|
Finding
|
Points
|
|
acute aggravation of a concurrent illness
|
absent
|
0
|
|
|
present
|
1
|
|
respiratory rate
|
< 25 breaths per minute
|
0
|
|
|
>= 25 breaths per minute
|
1
|
|
CRP
|
< 100 mg/L
|
0
|
|
|
>= 100 mg/L
|
1
|
where:
• Acute aggravation of a concurrent illness included: impaired glucose balance in a diabetic and worsening of congestive heart failure.
• The reference range and the analytical method for CRP were not given. In Tietz's Clinical Guide to Laboratory Tests, 3rd Edition the reference range is given as < 10 mg/L.
number of risk factors present =
= SUM(points for all 3 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 3
|
Number of Risk Factors Present
|
Mortality Rate
|
|
0 or 1
|
2.2%
|
|
2
|
|
|
3
|
20%
|
where:
• I was unable to locate the mortality rate for 2 risk factors. In the implementation I arbitrarily set this to 10%.
Limitations:
• The score needs to be validated in a prospective, randomized study.
