Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia

Authors

  • DAVID J. SERISIER,

    Corresponding author
    1. Department of Respiratory Medicine, Mater Adult Hospital
    2. University of Queensland, Mater Health Services
    3. Mater Medical Research Institute, South Brisbane
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  • SOPHIE WILLIAMS,

    1. Genesis Sleepcare, RiverCity Private Hospital, Auchenflower, Queensland, Australia
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  • SIMON D. BOWLER

    1. Department of Respiratory Medicine, Mater Adult Hospital
    2. University of Queensland, Mater Health Services
    3. Mater Medical Research Institute, South Brisbane
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  • Conflict of interest statement: D.J.S. has received honoraria for serving on the medical advisory boards of GSK, Pharmaxis and Phebra, and speaker's fees for presenting at educational meetings organized by GSK, AstraZeneca and Pharmaxis. S.D.B. has received honoraria for serving on the medical advisory boards of AstraZeneca and Novartis, speaker's fees for presenting at educational meetings organized by AstraZeneca, Novartis and Boehringer-Ingelheim, and travel to attend educational meetings by Pfizer.

David J. Serisier, Department of Respiratory Medicine, Level 9 Mater Adult Hospital, Raymond Tce, South Brisbane, Qld. 4101, Australia. Email: david.serisier@mater.org.au

ABSTRACT

Background and objective:  The value of community-acquired pneumonia (CAP) severity scoring tools is almost exclusively reliant upon regular and accurate application in clinical practice. Until recently, the Australasian Therapeutic Guidelines has recommended the use of the Pneumonia Severity Index (PSI) in spite of poor user-friendliness.

Methods:  Electronic and postal survey of respiratory and emergency medicine physician and specialist registrar members of the Royal Australasian College was undertaken to assess the use of the PSI and the accuracy of its application to hypothetical clinical CAP scenarios. The confusion, urea, respiratory rate, blood pressure, age 65 or older (CURB-65) score was also assessed as a simpler alternative.

Results:  Five hundred thirty-six (228 respiratory, 308 emergency) responses were received. Only 12% of respiratory and 35% of emergency physicians reported using the PSI always or frequently. The majority were unable to accurately approximate PSI scores, with significantly fewer respiratory than emergency physicians recording accurate severity classes (11.8% vs 21%, OR 0.50, 95% CI: 0.37–0.68, P < 0.0001). In contrast, significantly more respiratory physicians were able to accurately calculate the CURB-65 score (20.4% vs 15%, OR 1.45, 95% CI: 1.10–1.91, P = 0.006).

Conclusions:  Australasian specialist physicians primarily responsible for the acute management of CAP report infrequent use of the PSI and are unable to accurately apply its use to hypothetical scenarios. Furthermore, respiratory and emergency physicians contrasted distinctly in their use and application of the two commonest severity scoring systems—the recent recommendation of two further alternative scoring tools by Australian guidelines may add to this confusion. A simple, coordinated approach to pneumonia severity assessment across specialties in Australasia is needed.

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