Yesterday we reviewed the differential for shortness of breath and spoke about CAP.
The diagnosis of pneumonia is a clinical one with the history being the most important factor.
A chest xray will help confirm the clinical suspicion.
The clinical Prediction rule CURB65 is a simple scale to help decide if a patient needs to be admitted.
- C: confusion
- U: urea >7 mmol/l
- R: resp rate> 30
- B: BP: systolic <90 ; diastolic <60
- 65: age over 65
Each gives you 1 point. and the sum correlated to a 30 day mortatily rate: 0.6% if socare of 0, 1.7% with a score of 1,
Scores of 4 have a 15% 30 day mortality rate (this is High).
The general suggestion is score of 3 or more needs to be admitted, and 4 or more needs the ICU
This however, illustrated by our case, is just a tool, but NON a substitution for clinical judgment.
A newer study showed that a presenting O2 saturday of <92% in itself is a strong predictor of need for hospitalition .
The patient we discussed had presented with diarreah, AKI, elevated liver enzymes, and a slightly lowered sodium, which made the team suspicious of Legionnaires disease. Although these may be clues to consider this diagnosis, no clinical data can accurately predict this pathogen.
Here is a review article on legionnaires disease
Have a great weekend.
(Happy new year for those celebrating)
