Stalenhoef et al evaluated patients with a febrile community-acquired urinary tract infection. They reported a score for triaging the patient. The authors are from Leiden University, Erasmus University and multiple hospitals in The Netherlands.
PRACTICE = Prediction rule for admission policy in complicated urinary tract infection Leiden
Patient selection: >= 18 years with fever (temperature >= 38.0°C) and urinary tract infection
Exclusion: pregnancy, dialysis, renal transplant, polycystic renal disease
Parameters:
(1) sex and age
(2) residence
(3) malignancy (exclusion squamous cell carcinoma of skin; active in year prior to presentation)
(4) congestive heart failure (CHF)
(5) cerebrovascular disease
(6) liver cirrhosis
(7) chronic renal disease
(8) altered mental status
(9) respiratory rate in breaths per minute
(10) systolic blood pressure in mm Hg
(11) pulse in beats per minute
(12) body temperature in °C
|
Parameter |
Finding |
Points |
|
age and sex |
male |
(age) |
|
|
female |
(age) - 10 |
|
residence |
nursing home |
10 |
|
|
home |
0 |
|
malignancy |
absent |
0 |
|
|
present |
30 |
|
congestive heart failure |
absent |
0 |
|
|
present |
10 |
|
cerebrovascular disease |
absent |
0 |
|
|
present |
10 |
|
liver cirrhosis |
absent |
0 |
|
|
present |
20 |
|
renal disease |
absent |
0 |
|
|
present |
10 |
|
altered mental status |
absent |
0 |
|
|
present |
20 |
|
respiratory rate |
< 30 breaths/min |
0 |
|
|
>= 30 breaths/min |
20 |
|
systolic blood pressure |
< 90 mm Hg |
20 |
|
|
>= 90 |
0 |
|
pulse |
< 125 beats/min |
0 |
|
|
>= 125 beats/min |
10 |
|
body temperature |
< 40°C |
0 |
|
|
>= 40°C |
15 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 8
• maximum score: 275 (depends on age)
• The higher the score the more severe the infection is.
|
Score |
Manage |
90 Day Mortality |
|
< 75 |
as outpatient |
0 |
|
75 to 100 |
consider outpatient |
6% |
|
> 100 |
admit |
13% |
Specialty: Infectious Diseases
