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==Classification==
==Classification==
There is no established system for the classification of community-acquired pneumonia. However it can be classified according to severity using the Pneumonia Severity Index (PSI) score and CURB-65 Score.  
There is no established system for the classification of community-acquired pneumonia. However it can be categorized according to severity using the Pneumonia Severity Index (PSI) score and CURB-65 Score.  


The PSI score is calculated using factors like age, demographic factors, comorbid illnesses, physical exam findings, radiographic and laboratory findings. Based on these factors, the severity of the disease can be classified into five risk categories.  
The PSI score is calculated using factors like age, demographic factors, comorbid illnesses, physical exam findings, radiographic and laboratory findings. Based on these factors, the severity of the disease can be classified into five risk categories <ref name="pmidhttps://doi.org/10.1016/j.rmed.2004.02.022">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/j.rmed.2004.02.022 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>.  
Patients in Risk Class 1 to II can be managed in outpatient settings with oral antibiotics. Patients in Risk Class III can be managed in outpatient or inpatient settings after evaluation of risk factors. Patients in class IV and V should be admitted in the hospital for treatment. Risk Class I - III represents mortality of 0.1 - 0.9% whereas risk class V represent a 27% probability of mortality.  
Patients in Risk Class 1 to II can be managed in outpatient settings with oral antibiotics. Patients in Risk Class III can be managed in outpatient or inpatient settings after evaluation of risk factors. Patients in class IV and V should be admitted in the hospital for treatment. Risk Class I - III represents mortality of 0.1 - 0.9% whereas risk class V represent a 27% probability of mortality.  


The CURB-65 score is also used to categorize patients according to disease severity. It is calculated using the following factors:
The CURB-65 score is also used to categorize patients according to disease severity <ref name="pmid12728155">{{cite journal| author=Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI | display-authors=etal| title=Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. | journal=Thorax | year= 2003 | volume= 58 | issue= 5 | pages= 377-82 | pmid=12728155 | doi=10.1136/thorax.58.5.377 | pmc=1746657 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12728155  }} </ref>. It is calculated using the following factors:
  New onset of Confusion.
  New onset of Confusion.
  Blood Urea Nitrogen > 7 mmol/L or > 20 mg/dL.
  Blood Urea Nitrogen > 7 mmol/L or > 20 mg/dL.

Revision as of 01:39, 25 December 2020

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Overview

There is no established system for the classification of community-acquired pneumonia.

Classification

There is no established system for the classification of community-acquired pneumonia. However it can be categorized according to severity using the Pneumonia Severity Index (PSI) score and CURB-65 Score.

The PSI score is calculated using factors like age, demographic factors, comorbid illnesses, physical exam findings, radiographic and laboratory findings. Based on these factors, the severity of the disease can be classified into five risk categories [1]. Patients in Risk Class 1 to II can be managed in outpatient settings with oral antibiotics. Patients in Risk Class III can be managed in outpatient or inpatient settings after evaluation of risk factors. Patients in class IV and V should be admitted in the hospital for treatment. Risk Class I - III represents mortality of 0.1 - 0.9% whereas risk class V represent a 27% probability of mortality.

The CURB-65 score is also used to categorize patients according to disease severity [2]. It is calculated using the following factors:

New onset of Confusion.
Blood Urea Nitrogen > 7 mmol/L or > 20 mg/dL.
Respiratory Rate > 30 breaths/minute.
Blood pressure less than 90 mmHg SBP or less than 60 DBP.
Age > 65 years.

Patients can be treated as outpatient with a score of 0 - 1, whereas score of 3 - 5 requires hospitalization. CRB-65 is a simplified version of the score which is sometimes used in primary care settings for decision making. Hospitalization is recommended if one or more points are present.


References

  1. Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/j.rmed.2004.02.022 Check |pmid= value (help).
  2. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI; et al. (2003). "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study". Thorax. 58 (5): 377–82. doi:10.1136/thorax.58.5.377. PMC 1746657. PMID 12728155.