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Respiratory
Medicine, City Hospital, Nottingham NG5 1PB, UK
Correspondence to: Dr J T Macfarlane
Received 24 August 1999; Returned to authors 8 November 1999; Revised version received 30 November 1999; Accepted for publication 1 December 1999
BACKGROUND
The British
Thoracic Society (BTS) developed a rule (BTSr) based on severity
criteria to predict short term mortality in adults admitted to hospital
with community acquired pneumonia (CAP). However, neither the BTSr nor
a recent modification of it (mBTSr) have been validated in the UK. A
case-control study was conducted in a typical UK population to
determine the clinical factors predictive of mortality and to assess
the performance of these rules.
METHODSCases were
drawn from all patients with CAP who died in 1997 in five large
hospitals in the Mid Trent area. Controls were randomly selected from
survivors. Factors associated with mortality were identified following
review of medical case notes and performance of the severity prediction
rules assessed.
RESULTSAge >65
years, temperature <37°C, respiratory rate >24 breaths/min, mental
confusion, urea concentration of >7 mmol/l, sodium concentration of
<135 mmol/l, and the presence of a pleural effusion, all determined
on admission, were independently associated with in-hospital mortality
on multivariate analysis. The BTSr was 52% sensitive and 79% specific
in predicting death while the mBTSr displayed 66% sensitivity and 73% specificity.
CONCLUSIONSThe value
of three of the four factors (presence of mental confusion, raised
respiratory rate, raised urea) used in the mBTSr as predictors of
mortality is confirmed. However, the BTSr and mBTSr did not perform as
well in this validation study which included a high proportion (48%)
of elderly patients (
75 years) compared with the derivation studies.
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