Risk Score of Black et al for Hospitalization of an Ambulatory Patient with Pneumonia

 

Automatic reasons for admission (not candidates for risk score):

(1) systolic blood pressure < 100 mm Hg

(2) dehydration with hypernatremia (> 155 mEq/L), elevated BUN to creatinine ratio (> 20) or orthostatic blood pressure changes (> 20 mm Hg)

(3) hypoxia on room air (PaO2 < 55 mm Hg or arterial oxygen saturation < 90%)

(4) acute respiratory acidosis with pH < 7.30

(5) observed inability to take medications or fluids oral

(6) meningitis or other signs of disseminated infection

(7) presence of gram-negative rods in Gram stain of sputum

(8) unstable comorbid disease

 

Parameters:

(1) serious comorbid illness

(2) known lung disease (asthma, COPD, emphysema, chronic bronchitis and/or interstitial lung disease)

(3) aspiration

(4) infiltrate distribution

(5) duration of symptoms

 

Serious comorbid illnesses include:

(1) ischemic heart disease

(2) congestive heart failure

(3) renal disease

(4) diabetes mellitus

(5) malignancy

(6) poorly controlled hypertension

(7) immunodeficiency

Parameter	Finding	Points
serious comorbid illness	absent	0
	present	3
known lung disease	absent	0
	present	2
aspiration	none	0
	at risk due to stroke or other chronic neurologic disease	2
	likely	2
	observed	2
infiltrate	none	0
	unilobular	0
	multilobar	2
	other	0
symptoms	0 - 6 days	1
	7 - 28 days	0
	> 28 days	1

 

total risk score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 10

• The higher the score the greater the probability for hospitalization.

 

Total Score	Risk Group
0 - 2	low
3 - 5	intermediate
6 - 10	high