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Pneumonia Severity Index

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Pneumonia Severity Index, Pneumonia Hospitalization Criteria

  • See Also
  1. Pneumonia
  2. Pneumonia Management
  3. Pneumonia Hospitalization Criteria in the Elderly
  1. Triages patients to outpatient or inpatient management
  • Criteria
  1. General
    1. Age in years: ADD 1 point per year
    2. Gender: SUBTRACT 10 points for women
    3. Nursing Home resident: ADD 10 points
  2. Past medical history
    1. Cancer: ADD 30 points
    2. Liver Disease: ADD 20 points
    3. CHF: ADD 10 points
    4. CVA: ADD 10 points
    5. Chronic Kidney Disease: ADD 10 points
  3. Examination findings
    1. Altered Level of Consciousness: ADD 20 points
    2. Breathing Rate >30 rpm: ADD 20 points
    3. Systolic BP <90 mmHg: ADD 20 points
    4. Temperature not 95-104 F (35-40 C): Add 15 points
    5. Heart Rate >125 bpm: ADD 10 points
  4. Labs: Arterial Blood Gas (ABG)
    1. Arterial pH <7.35: ADD 30 points
    2. PaO2 <60 mmHg (<90% O2 Sat): ADD 10 points
  5. Labs: Serum Chemistry
    1. Serum Sodium <130 mEq/L: ADD 20 points
    2. Blood Urea Nitrogen (BUN) >64 mg/dl: ADD 20 points
    3. Serum Glucose >250 mg/dl: ADD 10 points
  6. Labs: Blood Count
    1. Hematocrit <30%: ADD 10 points
  7. Chest XRay
    1. Pleural Effusion: ADD 10 points
  • Scoring
  1. Class 1: Points 0: Mortality 0.1% (low risk)
  2. Class 2: Points <70: Mortality 0.6% (low risk)
  3. Class 3: Points 71-90: Mortality 2.8% (low risk)
  4. Class 4: Points 91-130: Mortality 8.2% (moderate risk)
  5. Class 5: Points >130: Mortality 29.2% (high risk)
  • Interpretation
  1. Class 1-2: Outpatient management
  2. Class 3: Consider short observation hospital stay
  3. Class 4-5: Inpatient management
  • References
  1. Fine (1997) N Engl J Med 336: 243-50 [PubMed]