UM Guidelines
Pneumonia Severity Index (PSI)

Ambulatory Care (AC) & Inpatient and Surgical Care (ISC)
BCBST modification effective September 27, 2007*
Deleted:
   
 

Milliman Care Guideline's Pneumonia Severity Index (PSI) calculator.
Added:

 

Pneumonia Severity Index (PSI)[A](2)
BCBST modification effective September 27, 2007*
 

Risk Factors

Patient Characteristic

Points

Point Tally

Demographic factors

Male

Age* in yrs

 

Female

Age* in yrs - 10
 

Nursing home resident

+10

Comorbid illnesses

Neoplastic disease[B]

+30
 

Liver disease[C]

+20
 

Congestive heart failure[D]

+10
 

Cerebrovascular disease[E]

+10
 

Renal disease[F]

+10

Physical examination

Altered mental status[G]

+20
 

Respiratory rate 30/min or more

+20
 

Systolic blood pressure less than 90 mm Hg

+20
   

Temperature 35 degrees C (95 degrees F) or less, or 40 degrees C (104 degrees F) or more

+15
 

Pulse 125/minute or more

+10

Laboratory

 

Arterial pH less than 7.35

+30
 

BUN 30 mg/dL (10.7 mmol/L) or more

+20
 

Sodium less than 130 mEq/L (mmol/L)

+20
 

Glucose greater than 250 mg/dL (13.88 mmol/L)

+10
   

Hematocrit less than 30% (0.30)

+10
  Arterial PO2 less than 60 mm Hg (8.0 kPa) or SaO2 less than 90 percent

+10
 

Pleural effusion

+10
   

Total PSI Points =

  

 

Suggested Actions Based on PSI Point Total

Total PSI Points

Risk Class

Mortality at 30 days (%)

Recommended Site of Care
Absence of predictors*

I

0.1 - 0.4

Outpatient
70 or less

II

0.6 - 0.7

Outpatient
71 - 90

III

0.9 - 2.8

Outpatient or brief inpatient
91 - 130

IV

8.2 - 9.3

Inpatient
130 or more

V

27.0 - 31.1

Inpatient

*If yourger than 50 years of age and no other risk factors present, assign patient to Risk Class I.

Pneumonia: New prediction model proves promising. Rockville, MD: U.S. Department of Health and Human Services, Agency for Health Care Policy and Research; 1997. AHCPR Publication 97-R031
Assessment of the variation and outcomes of pneumonia: Pneumonia Patient Outcomes Research Team (PORT). Final Report and Appendices. US Dept of Commerce, National Technical Information Service. NTIS Publication number PB97117808. Springfield, VA. June 28, 1996
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References

  1. Ramirez JA. Pneumonia severity index calculator. [Internet] Rockville, MD: Agency for Healthcare Research and Quality 2003 [posted 2003 Dec] Accessed at: http://pda.ahrq.gov.
  2. Aujesky D, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. American Journal of Medicine 2005;118(4):384-92.

    Footnotes

    [A] Immunocompromised patients (HIV positive, chronic prednisone greater than 10 mg/day or other immunosuppressive agents, prior organ transplantation, active cancer treatment, active tuberculosis, cystic fibrosis) require individual evaluation and assessment regarding need for admission.

    [B] Neoplastic disease means any cancer, except basal or squamous cell cancers of the skin, active at presentation or diagnosed within 1 year of presentation.

    [C] Liver disease means clinical or histologic diagnosis of cirrhosis or another form of chronic liver disease.

    [D] Congestive heart failure means systolic or diastolic dysfunction documented by history, physical examination and chest radiograph, echocardiogram, MUGA scan, or left ventriculogram.

    [E] Cerebrovascular disease means clinical diagnosis of stroke or transient ischemic attack or stroke documented by MRI or CT scan.

    [F] Renal disease means history of chronic renal disease or abnormal BUN and creatinine concentration documented in the medical record.

    [G] Altered mental status means disorientation to person, place, or time not known to be chronic, or stupor or coma.
* These guideline(s) have been revised from the Milliman USA Milliman Care Guidelines.  The portions of the guideline(s) which have been revised are identified through the use of [insert: italic, boldface, underlined, etc. as appropriate] text, and Milliman USA has neither reviewed nor approved the modified material.  Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. This document has been classified as public information.
The above information only contains the modified portion of the Milliman Care Guideline. If you wish to view the complete Milliman Care Guideline, please contact Milliman USA.