UM Guidelines
Pneumonia Severity Index (PSI)

Ambulatory Care (AC) & Inpatient and Surgical Care (ISC)
BCBST modification effective September 17, 2010*
Added:

 

Pneumonia Severity Index (PSI)[A](2)
 

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.
  3. BlueCross BlueShield of Tennessee network physicians. June - September 2010.

    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.