0071643192.pdf

THORACIC AND RESPIRATORY

DISORDERS

■ Cavitation

■ WBC count >30,000 or <4000 cells/mm^3

TREATMENT

■ ThePneumonia Patient Outcomes Research Team (PORT)score can
help guide decisions regarding the need for hospitalization in immuno-
competent adults (see Tables 10.10 and 10.11).

TABLE 10.10. PORT Prediction Rule for CAP

PATIENTCHARACTERISTIC POINTS ASSIGNEDa

Demographic factor

Age: men Number of years

Age: women Number of years minus 10

Nursing home resident 10

Comorbid illnesses

Neoplastic diseaseb 30

Liver diseasec 20

CHFd 10

Cerebrovascular diseasee 10

Renal diseasef 10

Physical examination finding

Altered mental statusg 20

Respiratory rate ≥30 breaths/min 20

Systolic BP <90 mmHg 20

Temperature≤35°C or ≥40°C 15

Pulse>−125 bpm 10

Laboratory or radiographic finding

Arterial pH <7. 3 5 3 0

BUN ≥30 mg/dL 20

Sodium<130 meq/L 20

Glucose>250 mg/dL 10

Hematocrit<30% 10

Arterial Po 2 <60 mmHg 10

Pleural effusion 10

(Adapted, with permission, from Fine MJ et al. “A prediction rule to identify low-risk patients with
community-acquired pneumonia.” NEJM. 1997(336):243. Copyright © 1997 Massachusetts
Medical Society. All rights reserved.)
aA total point score for a given patient is obtained by summing the patient’s age in years (age
minus 10 for women) and the points for each applicable characteristic.
bAny cancer except basal or squamous cell carcinoma of the skin that was active at the time of
presentation or diagnosed within 1 year before presentation.
cClinical or histologic diagnosis of cirrhosis or another form of chronic liver disease.
dSystolic or diastolic dysfunction documented by history, physical examination and CXR, echocar-
diogram, multiple uptake gated acquisition (MUGA) scan, or left ventriculogram.
eClinical diagnosis of stroke or TIA or stroke documented by MRI or CT scan.
fHistory of chronic renal disease or abnormal BUN and creatinine concentration documented in
the medical record.
gDisorientation (to person, place, or time, not known to be chronic), stupor, or coma.