Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia

Serisier, David J., Williams, Sophie and Bowler, Simon D. (2013) Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia. Respirology, 18 2: 291-296. doi:10.1111/j.1440-1843.2012.02275.x

Author Serisier, David J.
Williams, Sophie
Bowler, Simon D.
Title Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia
Journal name Respirology   Check publisher's open access policy
ISSN 1323-7799
Publication date 2013-02-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/j.1440-1843.2012.02275.x
Open Access Status Not yet assessed
Volume 18
Issue 2
Start page 291
End page 296
Total pages 6
Place of publication Richmond, VIC Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Background and objective: The value of community-acquired pneumonia (CAP) severity scoring tools is almost exclusively reliant upon regular and accurate application in clinical practice. Until recently, the Australasian Therapeutic Guidelines has recommended the use of the Pneumonia Severity Index (PSI) in spite of poor user-friendliness.
Methods: Electronic and postal survey of respiratory and emergency medicine physician and specialist registrar members of the Royal Australasian College was undertaken to assess the use of the PSI and the accuracy of its application to hypothetical clinical CAP scenarios. The confusion, urea, respiratory rate, blood pressure, age 65 or older (CURB-65) score was also assessed as a simpler alternative. Results: Five hundred thirty-six (228 respiratory, 308 emergency) responses were received. Only 12% of respiratory and 35% of emergency physicians reported using the PSI always or frequently. The majority were unable to accurately approximate PSI scores, with significantly fewer respiratory than emergency physicians recording accurate severity classes (11.8% vs 21%, OR 0.50, 95% CI: 0.37-0.68, P < 0.0001). In contrast, significantly more respiratory physicians were able to accurately calculate the CURB-65 score (20.4% vs 15%, OR 1.45, 95% CI: 1.10-1.91, P = 0.006).
Conclusions: Australasian specialist physicians primarily responsible for the acute management of CAP report infrequent use of the PSI and are unable to accurately apply its use to hypothetical scenarios. Furthermore, respiratory and emergency physicians contrasted distinctly in their use and application of the two commonest severity scoring systems - the recent recommendation of two further alternative scoring tools by Australian guidelines may add to this confusion. A simple, coordinated approach to pneumonia severity assessment across specialties in Australasia is needed. Australasian emergency and respiratory physicians infrequently use the PSI and are unable to apply it accurately. Two physician groups differed in their relative abilities to apply PSI and CURB-65, suggesting fragmented guideline dissemination. Australasian guidelines should promote a simple, coordinated pneumonia severity assessment tool that reaches across specialties.
Keyword Bacterial pneumonia
Community acquired pneumonia
Practice guideline
Severity scoring system
Prediction Rule
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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