Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia
Background. In most community-acquired pneumonia (CAP) treatment guidelines, the Pneumonia Severity Index (PSI) and CURB-65 are used as prognostic tools. Recently, simpler and more effective predictive tools for CAP treatment, such as the A-DROP scoring system, have been developed. However, no study...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2022/6391141 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850174939136524288 |
|---|---|
| author | Thanya Limapichat Suvanun Supavajana |
| author_facet | Thanya Limapichat Suvanun Supavajana |
| author_sort | Thanya Limapichat |
| collection | DOAJ |
| description | Background. In most community-acquired pneumonia (CAP) treatment guidelines, the Pneumonia Severity Index (PSI) and CURB-65 are used as prognostic tools. Recently, simpler and more effective predictive tools for CAP treatment, such as the A-DROP scoring system, have been developed. However, no study has performed a comparative evaluation to identify the superior tool for predicting when patients can be discharged safely. Objectives. To compare the performances of A-DROP and CURB-65, simple predictive tools for CAP, based on 30-day death rates and 72-hour revisit rates for CAP following discharge from the emergency department (ED). Method. This single-center retrospective observational study enrolled patients who were at least 18 years old and diagnosed with CAP at the Songklanagarind Hospital ED from January 2015 to April 2021. Following a severity assessment using the A-DROP and CURB-65 scoring systems, the 30-day mortality rates and 72-hour revisit rates after discharge from the ED were compared. Results. A total of 408 patients were enrolled in this study. Six (1.47%) died within 30 days after presentation, whereas 29 (7.1%) returned to the ED within 72 hours after discharge. Most patients (72%) who revisited the ED were over the age of 65 years. The areas under the receiver operating characteristic curves for the prediction of 30-day mortality were 0.756 (95% confidence interval [CI]: 0.526–0.987) and 0.808 (95% CI: 0.647–0.970) for A-DROP and CURB-65, respectively. The areas under the receiver operating characteristic curves for the prediction of 72-hour revisit were 0.617 (95% confidence interval [CI]: 0.507–0.728) and 0.639 (95% CI: 0.536–0.743) for A-DROP and CURB-65, respectively. Conclusion. A-DROP and CURB-65 yield similar results and can be used to assess low-risk patients with CAP for discharge from the ED. Older patients, even those with low-risk scores, should be particularly considered for admission to a short-term observation unit or ward. |
| format | Article |
| id | doaj-art-d6718e602e1f4647bc1379f0463ce117 |
| institution | OA Journals |
| issn | 2090-2859 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-d6718e602e1f4647bc1379f0463ce1172025-08-20T02:19:33ZengWileyEmergency Medicine International2090-28592022-01-01202210.1155/2022/6391141Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired PneumoniaThanya Limapichat0Suvanun Supavajana1Department of Emergency MedicineDepartment of Emergency MedicineBackground. In most community-acquired pneumonia (CAP) treatment guidelines, the Pneumonia Severity Index (PSI) and CURB-65 are used as prognostic tools. Recently, simpler and more effective predictive tools for CAP treatment, such as the A-DROP scoring system, have been developed. However, no study has performed a comparative evaluation to identify the superior tool for predicting when patients can be discharged safely. Objectives. To compare the performances of A-DROP and CURB-65, simple predictive tools for CAP, based on 30-day death rates and 72-hour revisit rates for CAP following discharge from the emergency department (ED). Method. This single-center retrospective observational study enrolled patients who were at least 18 years old and diagnosed with CAP at the Songklanagarind Hospital ED from January 2015 to April 2021. Following a severity assessment using the A-DROP and CURB-65 scoring systems, the 30-day mortality rates and 72-hour revisit rates after discharge from the ED were compared. Results. A total of 408 patients were enrolled in this study. Six (1.47%) died within 30 days after presentation, whereas 29 (7.1%) returned to the ED within 72 hours after discharge. Most patients (72%) who revisited the ED were over the age of 65 years. The areas under the receiver operating characteristic curves for the prediction of 30-day mortality were 0.756 (95% confidence interval [CI]: 0.526–0.987) and 0.808 (95% CI: 0.647–0.970) for A-DROP and CURB-65, respectively. The areas under the receiver operating characteristic curves for the prediction of 72-hour revisit were 0.617 (95% confidence interval [CI]: 0.507–0.728) and 0.639 (95% CI: 0.536–0.743) for A-DROP and CURB-65, respectively. Conclusion. A-DROP and CURB-65 yield similar results and can be used to assess low-risk patients with CAP for discharge from the ED. Older patients, even those with low-risk scores, should be particularly considered for admission to a short-term observation unit or ward.http://dx.doi.org/10.1155/2022/6391141 |
| spellingShingle | Thanya Limapichat Suvanun Supavajana Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia Emergency Medicine International |
| title | Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia |
| title_full | Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia |
| title_fullStr | Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia |
| title_full_unstemmed | Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia |
| title_short | Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia |
| title_sort | comparison between the severity scoring systems a drop and curb 65 for predicting safe discharge from the emergency department in patients with community acquired pneumonia |
| url | http://dx.doi.org/10.1155/2022/6391141 |
| work_keys_str_mv | AT thanyalimapichat comparisonbetweentheseverityscoringsystemsadropandcurb65forpredictingsafedischargefromtheemergencydepartmentinpatientswithcommunityacquiredpneumonia AT suvanunsupavajana comparisonbetweentheseverityscoringsystemsadropandcurb65forpredictingsafedischargefromtheemergencydepartmentinpatientswithcommunityacquiredpneumonia |