Pneumococcal pneumonia-are the new severity scores more accurate in predictingadverse outcomes? [Pneumonia pneumocócica-serão os novos scoresmais precisos a prever eventos desfavoráveis?]

Introduction: the site-of-care decision is one of the most important factors in the managementof patients with community-acquired pneumonia. the severity scores are validated prognostictools for community-acquired pneumonia mortality and treatment site decision. the aim of this paper was to compare the discriminatory power of four scores-the clas-sic psi and curb65 ant the most recent scap and smart-cop-in predicting major adverseevents: death,icu admission,need for invasive mechanical ventilation or vasopressor supportin patients admitted with pneumococcal pneumonia. methods: a five year retrospective study of patients admitted for pneumococcal pneumonia. patients were stratified based on admission data and assigned to low-,intermediate-,andhigh-risk classes for each score. results were obtained comparing low versus non-low riskclasses. results: we studied 142 episodes of hospitalization with 2 deaths and 10 patients needingmechanical ventilation and vasopressor support. the majority of patients were classified as lowrisk by all scores-we found high negative predictive values for all adverse events studied,themost negative value corresponding to the scap score. the more recent scores showed betteraccuracy for predicting icu admission and need for ventilation or vasopressor support (mostlyfor the scap score with higher auc values for all adverse events).conclusions: the rate of all adverse outcomes increased directly with increasing risk class inall scores. the new gravity scores appear to have a higher discriminatory power in all adverseevents in our study,particularly,the scap score. © 2012 sociedade portuguesa de pneumologia. published by elsevier españa,s.l. all rightsreserved.