UM Guidelines
Pneumonia Severity Index (PSI)

Ambulatory Care (AC) & Inpatient and Surgical Care (ISC)

 

 

 

Pneumonia Severity Index (PSI)

 

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 [A]

+30

 

Liver disease [B]

+20

 

CHF [C]

+10

 

Cerebrovascular disease [D]

+10

 

Renal disease [E]

+10

Physical examination

Altered mental status [F]

+20

 

Respiratory rate greater than 29 breaths per minute

+20

 

SBP less than 90 mm Hg

+20

 

Temperature less than 95 F (35 C) or more than 103.8 F (39.9 C)

+15

 

Pulse greater than 124 beats per minute

+10

Laboratory

pH less than 7.35

+30

 

BUN greater than 29 mg/dL (10.4 mmol/L)

+20

 

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

+20

 

Glucose greater than 249 mg/dL (13.8 mmol/L)

+10

 

Hematocrit less than 30% (0.30)

+10

  PO2 less than 60 mm Hg (8.0 kPa)

+10

 

Pleural effusion on x-ray

+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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Footnotes

[A] Neoplastic disease means any cancer (except basal or squamous cell cancers of the skin) active at presentation or diagnosed within one year of presentation.

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

[C] Heart failure means systolic or diastolic dysfunction documented by history, physical examination, echocardiogram, or other imaging tests.

[D] Cerebrovascular disease means history, clinical diagnosis or radiologic evidence of stroke or transient ischemic attack.

[E] Renal disease means history of chronic renal disease or significant acutely elevated creatinine concentration.

[F] Altered mental status means depressed level of consciousness, lethargy, or confusion.