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Evaluation
Identify patients with CAP who may be candidates for outpatient treatment
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Severity of illness scores (CURB-65 criteria): confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater; hospitalization with CURB-65 scores >2
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Pneumonia Severity Index to determine point of care
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Evaluation of signs, symptoms, and subjective factors
Direct UCI admission with one major or three mainor criteria for severe community-acquired pneumonia:
Minor criteria
(Other criteria to consider include hypoglycemia (in nondiabetic patients), acute alcoholism/alcoholic withdrawal, hyponatremia, unexplained metabolic acidosis or elevated lactate level, cirrhosis, and asplenia)
- Respiratory rate >30 breaths/min
- PaO2/FiO2 ratio <250
- Multilobar infiltrates
- Confusion/disorientation
- Uremia (BUN level, >20 mg/dL)
- Leukopenia as a result of infection alone (WBC count, <4000 cells/mm3)
- Thrombocytopenia (platelet count, < 100,000 cells/mm3)
- Hypothermia (core temperature, <36 degrees C)
- Hypotension requiring aggressive fluid resuscitation
Major criteria
- Invasive mechanical ventilation (or a need for noninvasive ventilation)
- Septic shock with the need for vasopressors
BIBLIOGRAPHIC SOURCE Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007 Mar 1;44 Suppl 2:S27-72.
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