American Thoracic Society Quick-Reference GUIDELINES Apps
Issue link: https://eguideline.guidelinecentral.com/i/91869
Diagnosis and Assessment of Disease Evaluation and Initial Management of CAP History, physical examination, chest radiograph No infiltrate: manage/evaluate for alternative diagnosis Infiltrate + compatible clinical features supporting diagnosis of pneumonia* Consider PSI, CURB-65, hypoxemia, patient factors† Determine site of care: Empirical therapy (Table 2) (PSI risk classes I, II, III; CURB-65 score 0-1) Mitigating factors Manage as outpatient no response to oral therapy, severe social or psychiatric problems, substance abuse, unstable living situation, homelessness) (eg, frail condition, hypoxemia, (PSI risk classes III, IV, V; Hospitalize patient CURB-65 score ≥ 2) * Compatible clinical features include but are not limited to fever, hypothermia, rigors, sweats, new cough with/without sputum production, change in color of secretions, chest discomfort, or onset of dyspnea. † Severity-of-illness scores, such as the CURB-65 criteria, or prognostic models, such as the PSI, can be used to identify patients with CAP who may be candidates for outpatient treatment. Such scores should always be supplemented with physician determination of subjective factors, including the ability to safely and reliably take oral medication and the availability of outpatient support resources. Certain patients with low PSI or CURB- 65 scores require hospital admission, even to the ICU (see "Key Points"). Hypoxemia on room air is a mitigating factor for admission. Table 1. CURB-65 Severity Scores for CAP Clinical Factors Confusion Blood urea nitrogen > 20 mg/dL Respiratory rate ≥ 30 breaths/min Systolic blood pressure < 90 mm Hg or diastole ≤ 60 Age > 65 Years Total Points: CURB-65 Score 0 1 2 3 4 or 5 2 Deaths (%)* 0.6 2.7 6.8 14.0 27.8 Recommendations† Low risk; consider home treatment Low risk; consider home treatment Admit to ward Severe pneumonia; hospitalize and consider admitting to intensive care CURB-65 = Confusion, Urea Nitrogen, Respiratory rate, Blood pressure, 65 years of age and older. *Data are weighted averages from validation studies. †Recommendations are consistent with British Thoracic Society guidelines. Clinical judgment may overrule guideline recommendations. Points 1 1 1 1 1