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Modified Clinical Pneumonia Scoring System of Moise et al

Purpose: To evaluate a patient with pneumonia using the clinical score of Moise et al (modification of the score of Luzier et al).

Description

Moise et al modified the clinical score of Luzier et al (previous section) 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.


NOTE: The differences between the 2 scores relate to the first 2 items. The score of Moise et al reference the chest exam, while the score of Luzier et al target the sputum Gram stain. It also uses temperature in °F rather than °C and serum albumin in g/dL rather than g/L.

 

Parameters:

(1) rales or crackles

(2) decreased breath sounds

(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

rales or crackles

none

1

 

mild

2

 

moderate

3

 

severe

4

breath sounds

normal

1

 

mild decrease

2

 

moderate decrease

3

 

severe decrease

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.

 

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.


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Specialty

Objective

ICD-10