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Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria

Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria Maggie McNally, James Curtain, Kirsty O’Brien, Borislav D Dimitrov, and Tom Fahey.

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Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria

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  1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria Maggie McNally, James Curtain, Kirsty O’Brien, Borislav D Dimitrov, and Tom Fahey Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria Maggie McNally, James Curtain, Kirsty O’Brien, Borislav D Dimitrov, and Tom Fahey

  2. CRB-65: a clinical prediction rule Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 1 or 2 0 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% Urgent hospital admission Likely suitable for home treatment Consider hospital referral

  3. Studies included in meta-analysis (n=14)

  4. Statistical Methods Derivation study used as predictive model Results presented as ratio measurement: predicted deaths by CRB-65 rule observed deaths in validation study

  5. Results

  6. CRB-65 Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 0 1 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31%

  7. n= 1025 events = 0 (0%) RR 9.41 (CI 1.75 – 50.66) n= 65802 events = 1555 (2.4%) RR 0.70 (CI 0.42 – 1.18)

  8. CRB-65 Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 0 1 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31%

  9. n= 765 events = 12 (1.6%) RR 4.84 (CI 2.61 – 8.96) n= 283 137 events = 37 745 (13.3%) RR 0.91 (CI 0.71 – 1.17)

  10. CRB-65 Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 0 1 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31%

  11. n= 27 events = 5 (18.5%) RR 1.58 (CI 0.59 – 4.19) n= 47119 events = 16158 (34.3%) RR 1.01 (CI 0.87 – 1.16)

  12. Conclusions

  13. Hospital Based Patients Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 0 1 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31%

  14. Community Based Patients • General trend towards over-prediction • However, • Low cohort numbers • Low event numbers

  15. Acknowledgements • RCSI Research Institute • Grainne McCabe, RCSI Library

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