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Published in Henry J. Woodford, Essential Geriatrics, 2022
Clinical tools have been developed to help rate CAP severity. The CURB-65 score gives one point for each of Confusion, a raised serum Urea (> 7 mmol/L), a respiratory Rate of 30 breaths per minute or over, a low Blood pressure (systolic < 90 mmHg or diastolic < 60 mmHg), and aged 65 or above. A modified version, the CRB-65, omits blood urea so that it can be more useful for initial assessment in community settings. A study of older people (mean age 77) with CAP found that 30-day mortality was < 1% for a CRB-65 score of zero or one, 8% for a score of two, and 17% for a score of three (no people had a score of four).12 Hospitalisation should be considered for people with a score of two or above. C-reactive protein (CRP) point of care testing has been shown to help reduce misdiagnosis among nursing home residents and reduce inappropriate antibiotic prescribing for people with suspected pneumonia.13
Respiratory Infections
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Patients who are well can be ambulated with oral antibiotics. Those who are unwell or have a CURB-65 score of three or more – 1 point each for confusion, urea >20 mg/dL, respiratory rate >30 breaths per minute, systolic blood pressure <90/60 mmHg and age >65 years – should be admitted to the nearest inpatient facility. With a CURB-65 score of 2 points, mortality is 9%, and these patients should be considered for inpatient management. Mortality with a CURB-65 score of 3–5 points is 15–40%. Give advice regarding smoking cessation.
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Pneumonia is an infection of the lung parenchyma. Patients commonly present with fever, worsening dyspnoea and a productive cough. It can be particularly severe in elderly patients, and is a common cause of death in this group. Pneumonia can be classified in numerous ways. Community-acquired pneumonia is commonly caused by S. pneumoniae, H. influenzae and M. pneumoniae. Atypical agents include Legionella pneumophila and S. aureus, among others. Hospital acquired/nosocomial pneumonia is defined as pneumonia that develops within 48 hours of hospital admission, and is often more severe due to antibiotic resistance. Gram-negative bacilli are often responsible, as is Pseudomonas aeruginosa. The CURB-65 score is used to determine the severity of community-acquired pneumonia and determine whether the patient is safe to be treated in the community or requires hospital admission. Antibiotics, IV fluids and oxygen, if necessary, are the mainstays of treatment.
Features of post-obstructive pneumonia in advanced lung cancer patients, a large retrospective cohort
Published in Infectious Diseases, 2023
Marco Moretti, Shauni Wellekens, Silke Dirkx, Karolien Vekens, Johan Van Laethem, Bart Ilsen, Eef Vanderhelst
In summary, the prevalence of POP in patients with lung cancer stages III and IV might be less than previously reported. In the current study, 11% of patients were affected by this type of pneumonia. Centrally located tumours and particularly SCC were associated with the development of POP, independent of age and comorbidities. POP should be considered in patients with hilar malignancy presenting with pneumonia and an extensive diagnostic work-up with CCT and bronchoscopy should be considered. Furthermore, the CURB-65 score at diagnosis of pneumonia was a discriminant for 30-day mortality. A value of two or greater had an excellent negative predictive value in this cohort, and its clinical application might be reasonable as it is easy to perform. Finally, a multidisciplinary approach to the disease, involving a respiratory physician, oncologist, infectious disease specialist, and radiologist specialised in chest imaging, should be considered as there is a high 30-day mortality and to date there are no evidence-based guidelines available.
Community-acquired pneumonia in hospitalised patients: changes in aetiology, clinical presentation, and severity outcomes in a 10-year period
Published in Annals of Medicine, 2022
Júlia Sellarès-Nadal, Joaquín Burgos, María Teresa Martín-Gómez, Andrés Antón, Roger Sordé, Daniel Romero-Herrero, Pau Bosch-Nicolau, Anna Falcó-Roget, Cristina Kirkegaard, Dolors Rodríguez-Pardo, Oscar Len, Vicenç Falcó
We collected epidemiologic information (age, sex, residency in nursing home, smoking, alcohol consumption and vaccination status), comorbidities (hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic renal failure, neurological disorders, and neoplasms) and immunosuppressive factors (solid organ transplantation, haematopoietic transplantation, chemotherapy, long-term use of corticosteroids, and HIV infection). We also registered clinical information, laboratory results, radiological findings, microbiological information, and severity data (septic shock and respiratory failure). Empirical treatment was recorded. Evolutive variables, such as admission at the Intensive Care Unit (ICU) and in-hospital mortality were collected. CURB-65 score and Pneumonia Severity Index (PSI) were calculated.
Elderly People with Dementia Admitted for COVID-19: How Different are They?
Published in Experimental Aging Research, 2022
Noel Roig-Marín, Pablo Roig-Rico
From our population of 300 hospitalizations, 54 of these patients had dementia and 246 did not have dementia. The main objective was to determine whether there were differences in mortality rates. From our study, it has been observed that in-hospital mortality in the context of admission for COVID-19 is significantly higher in patients without dementia (14.8% vs. 28.9%; p = .03) (Table 1A). The reason why there is a higher in-hospital mortality rate among patients without dementia is that 50% of patients with dementia come from nursing homes in which patients, despite presenting mild or non-existent symptoms, are more easily referred to hospitals. Consequently, elderly patients with dementia on admission less frequently present high severity scores, e.g., CURB-65 and PORT Score, that have an impact on in-hospital mortality. CURB-65 is a severity score for community acquired pneumonia which was used in COVID-19 pandemics and is a predictor of mortality too. CURB-65 stands for confusion, urea, respiratory rate, and blood pressure among patients aged ≥65. The PORT score (Pneumonia Patient Outcomes Research Team) is a pneumonia severity index (PSI), such as CURB-65, and it can estimate probability of morbidity and mortality in patients with pneumonia. Both scores were used by medical practitioners in the Hospital of San Juan of Alicante. High scores on these two tests imply a worse prognosis and a higher risk of mortality. In the context of our hospital during the COVID-19 pandemic in 2020, patients with dementia presented lower severity scores, which implied a better prognosis and lower in-hospital mortality.