Predicting severity of community-acquired pneumonia with the Pneumonia Severity Index (PSI) score
The PSI prediction rule accurately identifies the patients with community-acquired pneumonia who are at low risk for death and other adverse outcomes. This prediction rule may help physicians make more rational decisions about hospitalization for patients with pneumonia.
Research authors: Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, and Kapoor WN.
  • Pulmonology
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Total pneumonia severity index (PSI) score: points

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How this model should be used:
The PSI prediction rule identifies three distinct risk classes (I, II, and III) of patients who are at sufficiently low risk for death and other adverse medical outcomes that physicians can consider outpatient treatment or an abbreviated course of inpatient care for them.1 The risk stratification provided by de PSI model could also help target low-risk patients at the time of admission for whom rapid conversion from intravenous to oral antimicrobial therapy and early discharge might be appropriate.

Model performance: 
No significant differences in mortality in each of the five PSI risk classes were found among three large study cohorts:

  • MedisGroups derivation cohort (N=14,199 patients)
  • MedisGroups validation cohort (N=38,039 patients)
  • PORT validation cohort (N=2287 patients)
Although this study provides preliminary evidence that the PSI prediction rule could help physicians determine when hospital care is appropriate for patients with community-acquired pneumonia, firm recommendations for its clinical use will depend on future prospective trials to confirm its effectiveness and safety. Furthermore, although the PSI exhibits a high discriminatory power for assigning appropriate risk class, it is complicated to calculate, limiting its clinical application.

  1. Fine MJ, Auble TE, Yealy DM et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.

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