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Andres Canut - One of the best experts on this subject based on the ideXlab platform.
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uso rutinario del Pneumonia Severity Index en el servicio de urgencias efecto sobre los indicadores de proceso y resultado en neumonia adquirida en la comunidad
Enfermedades Infecciosas Y Microbiologia Clinica, 2013Co-Authors: Miriam Delgado, Mar Alvarez, Ines Carrascosa, Maria Rodriguezvelasco, Jose Luis Barrios, Andres CanutAbstract:Resumen Objetivos Evaluacion de indicadores de proceso (hospitalizacion inadecuada, adecuacion y precocidad de antibioterapia) y resultado (estancia hospitalaria, reingresos, ingresos UCI y mortalidad) de neumonia adquirida en la comunidad (NAC) al aplicar la guia SEPAR/IDSA. Pacientes y metodos Estudio observacional retrospectivo de pacientes consecutivos con diagnostico al alta de NAC en los primeros semestres de 2007 y 2008 (186 y 161 pacientes, respectivamente) atendidos en urgencias de hospital general. Se han analizado las diferencias en los indicadores entre los grupos de pacientes con/sin Pneumonia Severity Index (PSI) calculado, segun el ano de implantacion de la guia, y se compararon con los de 110 pacientes de 2006 segun la guia SEQ/ATS. Resultados La guia SEPAR/IDSA ha mejorado los indicadores de proceso: mayor adecuacion del ambito de tratamiento, disminucion de ingresos injustificados (del 39,4% en 2006 al 8,5% en 2007 [p Conclusion La guia SEPAR/IDSA ha reducido los ingresos injustificados y en el segundo ano de aplicacion se ha observado mayor precocidad de la antibioterapia junto a una reduccion de la mortalidad en los pacientes con riesgo moderado-alto en los que se calculo el PSI.
Suyastri Suyastri - One of the best experts on this subject based on the ideXlab platform.
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Perbandingan Expanded Curb-65 Terhadap Curb-65 dan Psi Dalam Memprediksi Luaran Pasien Cap
Lembaga Layanan Pendidikan Tinggi (LLDIKTI) Wilayah X, 2019Co-Authors: Suyastri Suyastri, Medison Irvan, Herman Deddy, Russilawati RussilawatiAbstract:Tingkat keparahan CAP adalah poin penting pengambilan keputusan perawatan pasien. Beberapa metode telah digunakan untuk menilai tingkat keparahan Pneumonia seperti Pneumonia Severity Index (PSI), CURB-65, SMART-COP dan Expanded CURB-65. Metode tersebut memiliki kelebihan dan kekurangan. Expanded CURB 65 diusulkan menjadi metode yang lebih akurat untuk mengevaluasi keparahan Pneumonia dan memprediksi kematian pasien CAP. Tujuan penelitian ini memprediksi keakuratan Expanded CURB 65 dibandingkan CURB 65 dan PSI. Penelitian kohort prospektif pada pasien CAP yang dirawat di RSUP Dr. M.Djamil Padang dari April sampai Oktober 2019. Tingkat keparahan CAP pada pasien dinilai menggunakan PSI, CURB 65, Expanded CURB 65, kemudian hasilnya dievaluasi berdasarkan keparahan. Data dianalisis menggunakan regresi logistik dengan CI 95% dan nilai p <0,05 dianggap signifikan. Hasil penelitian pada 90 pasien sebagian besar laki-laki usia 53 tahun dengan komorbiditas terbanyak keganasan. Uji Pearson Chi aquare menunjukkan tidak ada hubungan antara tingkat keparahan berdasarkan CURB 65 dan luaran pengobatan (CI 95%, nilai p = 0,104). Sementara, PSI dan Expanded CURB 65 memiliki hubungan yang signifikan antara tingkat keparahan dan luaran (CI 95%, p=0,081 dan CI 95%, p= 0,046, masing-masing). Analisis multivariat menemukan Expanded CURB 65 lebih akurat dalam memprediksi luaran pasien CAP rawat inap (kappa =0,108 dan AUC=0,422).Severity of CAP is very important for site care decision inpatients. Several methods have been used to assess the Severity of Pneumonia such as Pneumonia Severity Index (PSI), CURB-65, SMART-COP and Expanded CURB-65. Those methods have advantages and disadvantages. Expanded CURB 65 is proposed to be more accurate method for evaluating Pneumonia Severity and predicting mortality in CAP. The aim of this study was to investigate the accuracy of Expanded CURB 65 compare to CURB 65 and PSI. Cohort prospective study was conducted for CAP patients who were hospitalized at RSUP Dr. M.Djamil Padang from April to October 2019. Patients was assesed for Severity using PSI, CURB 65, Expanded CURB 65, then we evaluated it’s outcome. The data were analyzed by logistic regression with CI 95% and p value <0,05 considered as statistically significant. We found 90 patients that predominantly males with an average age of 53 years, and the most common comorbidity is malignancy. There was no relationship between Pneumonia Severity by CURB 65 and outcome (CI 95%, p=0.104). PSI and Expanded CURB 65 had significant relationship between Severity and outcome (CI 95%, p=0.081and CI 95%, p=0.046, respectively). Multivariate analysis showed the expanded CURB 65 was more accurate for predicting the outcome of CAP inpatients (kappa=0.108 and AUC= 0.422)
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PERBANDINGAN EXPANDED CURB 65 TERHADAP CURB 65 DAN PSI DALAM MEMPREDIKSI LUARAN PENGOBATAN PASIEN CAP YANG DI RAWAT DI RSUP DR. M. DJAMIL PADANG
2019Co-Authors: Suyastri SuyastriAbstract:Latar belakang:Tingkat keparahan CAP adalah poin penting pengambilan keputusan perawatan pasien. Beberapa metode telah digunakan untuk menilai tingkat keparahan Pneumonia seperti Pneumonia Severity Index (PSI), CURB-65, SMART-COP dan Expanded CURB-65. Metode tersebut memiliki kelebihan dan kekurangan. Expanded CURB 65 diusulkan menjadi metode yang lebih akurat untuk mengevaluasi keparahan Pneumonia dan memprediksi kematian pasien CAP. Tujuan penelitian ini memprediksi keakuratan Expanded CURB 65 dibandingkan CURB 65 dan PSI. Metode:Penelitian kohort prospektif pada pasien CAP yang dirawat di RSUP Dr. M.Djamil Padang dari April sampai Oktober 2019. Tingkat keparahan CAP pada pasien dinilai menggunakan PSI, CURB 65, Expanded CURB 65, kemudian hasilnya dievaluasi berdasarkan keparahan. Data dianalisis menggunakan regresi logistik dengan CI 95% dan nilai p
Michael J Fine - One of the best experts on this subject based on the ideXlab platform.
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reasons why emergency department providers do not rely on the Pneumonia Severity Index to determine the initial site of treatment for patients with Pneumonia
Clinical Infectious Diseases, 2009Co-Authors: Drahomir Aujesky, Donald M Yealy, Michael J Fine, Scott D Obrosky, Julie B Mccausland, Jeff WhittleAbstract:BACKGROUND: Many emergency department (ED) providers do not follow guideline recommendations for the use of the Pneumonia Severity Index (PSI) to determine the initial site of treatment for patients with community-acquired Pneumonia (CAP). We identified the reasons why ED providers hospitalize low-risk patients or manage higher-risk patients as outpatients. METHODS: As a part of a trial to implement a PSI-based guideline for the initial site of treatment of patients with CAP, we analyzed data for patients managed at 12 EDs allocated to a high-intensity guideline implementation strategy study arm. The guideline recommended outpatient care for low-risk patients (nonhypoxemic patients with a PSI risk classification of I, II, or III) and hospitalization for higher-risk patients (hypoxemic patients or patients with a PSI risk classification of IV or V). We asked providers who made guideline-discordant decisions on site of treatment to detail the reasons for nonadherence to guideline recommendations. RESULTS: There were 1,306 patients with CAP (689 low-risk patients and 617 higher-risk patients). Among these patients, physicians admitted 258 (37.4%) of 689 low-risk patients and treated 20 (3.2%) of 617 higher-risk patients as outpatients. The most commonly reported reasons for admitting low-risk patients were the presence of a comorbid illness (178 [71.5%] of 249 patients); a laboratory value, vital sign, or symptom that precluded ED discharge (73 patients [29.3%]); or a recommendation from a primary care or a consulting physician (48 patients [19.3%]). Higher-risk patients were most often treated as outpatients because of a recommendation by a primary care or consulting physician (6 [40.0%] of 15 patients). CONCLUSION: ED providers hospitalize many low-risk patients with CAP, most frequently for a comorbid illness. Although higher-risk patients are infrequently treated as outpatients, this decision is often based on the request of an involved physician.
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the Pneumonia Severity Index a decade after the initial derivation and validation
Clinical Infectious Diseases, 2008Co-Authors: Drahomir Aujesky, Michael J FineAbstract:The prognosis of community-acquired Pneumonia ranges from rapid resolution of symptoms and full recovery of functional status to the development of severe medical complications and death. The Pneumonia Severity Index is a rigorously studied prediction rule for prognosis that objectively stratifies patients into quintiles of risk for short-term mortality on the basis of 20 demographic and clinical variables routinely available at presentation. The Pneumonia Severity Index was derived and validated with data on >50,000 patients with community-acquired Pneumonia by use of well-accepted methodological standards and is the only Pneumonia decision aid that has been empirically shown to safely increase the proportion of patients given treatment in the outpatient setting. Because of its prognostic accuracy, methodological rigor, and effectiveness and safety as a decision aid, the Pneumonia Severity Index has become the reference standard for risk stratification of community-acquired Pneumonia.
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investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes a european study
Clinical Microbiology and Infection, 2007Co-Authors: B Renaud, E Coma, J Hayon, Merce Gurgui, C Longo, M Blancher, I Jouannic, S Betoulle, E Roupie, Michael J FineAbstract:In order to confirm the validity of the Pneumonia Severity Index (PSI) for patients in Europe, data from adults with Pneumonia who were enrolled in two prospective multicentre studies, conducted in France (Pneumocom-1, n = 925) and Spain (Pneumocom-2, n = 853), were compared with data from the original North American study (Pneumonia PORT, n = 2287). The primary outcome was 28-day mortality; secondary outcomes were subsequent hospitalisation for outpatients, and intensive care unit admission and length of stay for inpatients. All outcomes within individual risk classes, and mortality rates in low-risk (PSI I–III) and higher-risk patients, were compared across the three cohorts. Overall mortality rates were 4.7% in Pneumonia PORT, 6.3% in Pneumocom-2 and 10.6% in Pneumocom-1 (p <0.01), ranging from 0.4% to 1.6% (p 0.06) for low-risk patients and from 13.0% to 19.1% (p 0.24) for high-risk patients. Despite significant differences in baseline patient characteristics, none of the study outcomes differed within the low-risk classes. The sensitivity and negative predictive value of low-risk classification for mortality exceeded 93% and 98%, respectively. Thus, in two independent European cohorts, the PSI predicted patient outcomes accurately and reliably, particularly for low-risk patients. These findings confirm the validity of the PSI when applied to patients from Europe.
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using randomized controlled trial data the agreement between retrospectively and prospectively collected data comprising the Pneumonia Severity Index was substantial
Journal of Clinical Epidemiology, 2005Co-Authors: Drahomir Aujesky, Donald M Yealy, Roslyn A Stone, Scott D Obrosky, Thomas E Auble, Thomas P Meehan, Louis Graff, Jonathan M Fine, Michael J FineAbstract:OBJECTIVE: To assess the agreement between prospectively and retrospectively determined variables comprising the Pneumonia Severity Index (PSI), assignment to PSI risk class, and designation as low risk, based on these two methods of data collection. STUDY DESIGN AND SETTING: We analyzed data from a randomized trial of patients with community-acquired Pneumonia managed in 32 hospital emergency departments (EDs). For all enrolled patients, the 20 PSI variables were collected prospectively by ED providers and retrospectively by medical record abstractors. We examined the agreement for each of the 20 PSI variables, assignment to the five PSI risk classes, and classification of patients as low (classes I-III) vs. high (classes IV and V) risk. Agreement was measured using total percent agreement and the kappa statistic. RESULTS: Among the 3,220 enrolled patients, percent agreement was >90% for 18 of the 20 variables comprising the PSI, with most unweighted kappa's being >0.6. Agreement was substantial for assignment to PSI risk class (percent agreement: 92.7%; weighted kappa: 0.79) and for classification as low vs. high risk (percent agreement: 88.5%; unweighted kappa: 0.74). CONCLUSION: There was substantial agreement between retrospective and prospective assignment to PSI risk class, classification as low vs. high risk, and the determination of most individual variables that constitute the PSI.
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severe community acquired Pneumonia use of intensive care services and evaluation of american and british thoracic society diagnostic criteria
American Journal of Respiratory and Critical Care Medicine, 2002Co-Authors: Derek C Angus, Michael J Fine, Scott D Obrosky, Thomas J Marrie, Gilles Clermont, Tony T Dremsizov, Christopher M Coley, Daniel E Singer, Wishwa N KapoorAbstract:Despite careful evaluation of changes in hospital care for community-acquired Pneumonia (CAP), little is known about intensive care unit (ICU) use in the treatment of this disease. There are criteria that define CAP as “severe,” but evaluation of their predictive value is limited. We compared characteristics, course, and outcome of inpatients who did (n = 170) and did not (n = 1,169) receive ICU care in the Pneumonia Patient Outcomes Research Team prospective cohort. We also assessed the predictive characteristics of four prediction rules (the original and revised American Thoracic Society criteria, the British Thoracic Society criteria, and the Pneumonia Severity Index [PSI]) for ICU admission, mechanical ventilation, medical complications, and death (as proxies for severe CAP). ICU patients were more likely to be admitted from home and had more comorbid conditions. Reasons for ICU admission included respiratory failure (57%), hemodynamic monitoring (32%), and shock (16%). ICU patients incurred longer ho...
Julio A Ramirez - One of the best experts on this subject based on the ideXlab platform.
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predictive accuracy of the Pneumonia Severity Index vs crb 65 for time to clinical stability results from the community acquired Pneumonia organization capo international cohort study
Respiratory Medicine, 2010Co-Authors: Forest W Arnold, Guy N Brock, Paula Peyrani, Eduardo Rodriguez, Alejandro A Diaz, P Rossi, Julio A RamirezAbstract:Summary Background: The Pneumonia Severity Index (PSI) and CRB-65 are scores used to predict mortality in patients with community-acquired Pneumonia (CAP). It is unknown how well either score predicts time to clinical stability in hospitalized patients with CAP. Thus, it is also not known which score predicts time to clinical stability better. Methods: A secondary analysis of 3087 patients from the Community-Acquired Pneumonia Organization (CAPO) database was performed. Time-dependent receiver-operator characteristic (ROC) curves for time to clinical stability were calculated for the PSI and CRB-65 scores at day seven of hospitalization. Secondary outcomes were to assess the relationship of the PSI and CRB-65 to in-hospital mortality and length of stay (LOS). ROC curves for LOS and mortality were calculated. Results: The area under the ROC curve (AUC) for time to clinical stability by day seven was 0.638 (95% CI 0.613, 0.660) when using the PSI, and 0.647 (95% CI 0.619, 0.670) while using
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the Pneumonia Severity Index and the crb 65 in cancer patients with community acquired Pneumonia
International Journal of Tuberculosis and Lung Disease, 2009Co-Authors: Stefano Aliberti, Paula Peyrani, Guy N Brock, Francesco Blasi, Julio A RamirezAbstract:CONTEXTE: On n'a pas evalue jusqu'ici la capacite de l'Index de gravite de la pneumonie (PSI) et du CRB-65 pour identifier, parmi les patients cancereux atteints d'une pneumonie acquise en communite (CAP), ceux ayant un risque eleve ou faible de mortalite. SCHEMA: On a identifie dans la base de donnees de l'Organisation des pneumonies acquises dans la collectivite (CAPO) les sujets atteints de cancer, CAP/Ca(+), et sans cancer, CAP/Ca(—). La mortalite des deux groupes a ete analysee en comparant les cas a risque eleve de mortalite selon le PSI (classes de risque I, II et III vs. IV et V) et selon le score CRB-65 (score 0 et 1 vs. 2, 3 et 4). RESULTATS: Ont ete inclus 2621 patients dans le groupe CAP/Ca(-) et 280 dans le groupe CAP/Ca(+). Dans le groupe CAP/Ca(+), on n'a detecte aucune difference significative de mortalite dans la population a risque faible vs. eleve, que ce soit selon le PSI (P = 0,288) ou selon le score CRB-65 (P = 0,281). Les Index de concordance obtenus par l'analyse des courbes caracteris-tiques des operateurs recepteurs ont ete respectivement de 0,53 et 0,54 dans le groupe CAP/Ca(+), pour le PSI et le score CRB-65. En appliquant un modele de regression multivariee, une tendance significativement differente vers la mortalite a ete observee entre le groupe CAP/Ca(-) et le groupe CAP/Ca(+) pour les deux systemes de score. CONCLUSION: Pour definir le site de soins a choisir pour les patients cancereux atteints de CAP, c'est l'appreciation clinique qui continuera a constituer l'outil principal des medecins.
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hospitalization for community acquired Pneumonia the Pneumonia Severity Index vs clinical judgment
Chest, 2003Co-Authors: Forest W Arnold, Julio A Ramirez, Clifford L Mcdonald, Eric L XiaAbstract:Study objectives (1) To define clinical factors that could justify hospital admission among patients with community-acquired Pneumonia (CAP) with risk classes of I or II. (2) To determine the positive predictive value of the Pneumonia Severity Index as the sole indicator for detecting inappropriate hospitalizations among patients with CAP. Design Retrospective observational study. Setting University of Louisville Hospital and the Veterans Affairs Medical Center of Louisville, KY. Patients Consecutive adult patients fulfilling the criteria for CAP who were admitted to the hospital between October 1997 and May 2000. Measurements and results The medical records of hospitalized patients with CAP having a risk class of I or II were identified and further reviewed to determine whether there existed a clinical basis to justify hospitalization. Of a total of 328 patients, 86 had a risk class of I or II. Among these, 72 had clinical factors that justified their hospital admission. These factors, in frequency of occurrence, included the following: medical conditions other than CAP that required hospitalization, 31 patients (43%); social needs, 13 patients (18%); oral intolerance, 10 patients (14%); failure of outpatient therapy, 10 patients (14%); noncompliance, 6 patients (9%); suspicion of sepsis, 1 patient (1%); and hypoxemia, 1 patient (1%). Among the 86 patients with low risk classes (ie, classes I or II), 14 were found to be inappropriately hospitalized, yielding a positive predictive value of 16%. Conclusions The Pneumonia Severity Index, used as the sole indicator for detecting inappropriate hospitalizations, has an unacceptably low positive predictive value. This is due primarily to the Severity of comorbid conditions requiring in-hospital care in patients with a nonsevere Pneumonia. According to our study, the Pneumonia Severity Index should not be used as the sole indicator with which to define inappropriate hospitalization.
Miriam Delgado - One of the best experts on this subject based on the ideXlab platform.
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uso rutinario del Pneumonia Severity Index en el servicio de urgencias efecto sobre los indicadores de proceso y resultado en neumonia adquirida en la comunidad
Enfermedades Infecciosas Y Microbiologia Clinica, 2013Co-Authors: Miriam Delgado, Mar Alvarez, Ines Carrascosa, Maria Rodriguezvelasco, Jose Luis Barrios, Andres CanutAbstract:Resumen Objetivos Evaluacion de indicadores de proceso (hospitalizacion inadecuada, adecuacion y precocidad de antibioterapia) y resultado (estancia hospitalaria, reingresos, ingresos UCI y mortalidad) de neumonia adquirida en la comunidad (NAC) al aplicar la guia SEPAR/IDSA. Pacientes y metodos Estudio observacional retrospectivo de pacientes consecutivos con diagnostico al alta de NAC en los primeros semestres de 2007 y 2008 (186 y 161 pacientes, respectivamente) atendidos en urgencias de hospital general. Se han analizado las diferencias en los indicadores entre los grupos de pacientes con/sin Pneumonia Severity Index (PSI) calculado, segun el ano de implantacion de la guia, y se compararon con los de 110 pacientes de 2006 segun la guia SEQ/ATS. Resultados La guia SEPAR/IDSA ha mejorado los indicadores de proceso: mayor adecuacion del ambito de tratamiento, disminucion de ingresos injustificados (del 39,4% en 2006 al 8,5% en 2007 [p Conclusion La guia SEPAR/IDSA ha reducido los ingresos injustificados y en el segundo ano de aplicacion se ha observado mayor precocidad de la antibioterapia junto a una reduccion de la mortalidad en los pacientes con riesgo moderado-alto en los que se calculo el PSI.