Luzier et al developed a clinical scoring system for evaluating a patient with pneumonia. This can be used at the time of diagnosis and to monitor the patient's response to therapy. The authors are from Millard Fillmore Hospital and State University of New York at Buffalo.
Parameters:
(1) number of organisms seen on Gram stain per high powered field (hpf)
(2) number of white blood cells on Gram stain per high powered field (hpf)
(3) oxygen use
(4) WBC count in the peripheral blood
(5) percent bands in the differential count of the peripheral blood smear
(6) number of tubes ("tube sign")
(7) amount of sputum or tracheal (respiratory) secretions
(8) maximum body temperature in °C
(9) serum albumin in g/dL
(10) CNS status
|
Parameter |
Finding |
Points |
|
bacteria per hpf on Gram stain |
0 |
1 |
|
|
1 or 2 (few) |
2 |
|
|
3 to 10 (moderate) |
3 |
|
|
>= 11 (many) |
4 |
|
WBC per hpf in Gram stain |
0 |
1 |
|
|
1 to 5 |
2 |
|
|
6 to 24 |
3 |
|
|
>= 25 |
4 |
|
oxygen use (FIO2) |
room air |
1 |
|
|
<= 0.4; on mask or T vent |
2 |
|
|
0.41 to 0.60; on ventilator |
3 |
|
|
> 0.60; on ventilator |
4 |
|
WBC count |
<= 10,000 per µL |
1 |
|
|
10,001 to 15,000 per µL |
2 |
|
|
15,001 to 30,000 per µL |
3 |
|
|
> 30,000 per µL |
4 |
|
percent bands |
<= 5% |
1 |
|
|
5.1 to 15% |
2 |
|
|
15.1 to 39.9% |
3 |
|
|
>= 40% |
4 |
|
number of tubes |
0,1 or 2 |
1 |
|
|
3, 4 or 5 |
2 |
|
|
6, 7, 8 or 9 |
3 |
|
|
>= 10 |
4 |
|
amount of respiratory secretions |
normal |
1 |
|
|
cough occasionally; suction every shift |
2 |
|
|
cough continuously; suction every 2-3 hours |
3 |
|
|
suction over 0.5 to 1 hour |
4 |
|
maximum body temperature |
36.1 to 37.2°C |
1 |
|
|
37.3 to 38.2°C |
2 |
|
|
38.3 to 39.3°C |
3 |
|
|
>= 39.4°C |
4 |
|
serum albumin |
>= 3.9 g/dL |
1 |
|
|
3.0 to 3.8 g/dL |
2 |
|
|
1.9 to 2.9 g/dL |
3 |
|
|
< 1.9 g/dL |
4 |
|
CNS status |
alert and fully oriented |
1 |
|
|
alert but not fully oriented |
2 |
|
|
not alert, responds only to pain |
3 |
|
|
unresponsive |
4 |
where:
• Hypothermia and leukopenia are not scored.
• Tubes include endotracheal tube, Foley catheter, indwelling venous catheter, central lines, etc.
• CNS status might use another category for not alert but responds to voice or shaking.
• The magnification of the high power field is not given but I assume it uses a 40x objective and not an oil lens (100x).
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 10
• maximum score: 40
• The higher the score the more clinically severe the pneumonia.
• A patient responding to therapy should show a decrease in the score.
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,
