High risk categories:
(1) complicated disease = clinically severe disease
(2) unstable pneumonia
Complicated pneumonia - one or more of the following:
(1) necrotizing pneumonia
(2) lung abscess
(3) empyema
(4) endocarditis
(5) meningitis
(6) septic arthritis
(7) septic shock
(8) respiratory and/or other organ failures
Unstable pneumonia:
(1) comorbid conditions
(1a) chronic liver disease
(1b) renal insufficiency or renal failure
(1c) COPD or other chronic pulmonary disease
(1d) malnutrition
(1e) drug and/or alcohol withdrawal
(1f) heart failure
(1g) uncontrolled diabetes
(1h) immunocompromised
(1i) cerebrovascular disease
(2) clinical findings
(2a) unstable vital signs
(2b) unable to take oral medication
(2c) change in mental status
(2d) problems in handling secretions
(2e) volume depletion
(2f) hypothermia or severe hyperthermia
(3) social findings
(3a) homeless
(3b) frail elderly
(3c) noncompliant
(3d) unstable home environment
(4) radiographic findings
(4a) multilobar infiltrate
(4b) pleural effusion
(5) laboratory findings
(5a) anemia
(5b) hypoxemia
(5c) hyponatremia
(5d) leukopenia or severe leukocytosis
(5e) acidosis
(5f) high risk pathogen
If none of these findings are present, then the patient is low-risk.
