TITLE:
Validation of a Risk-Based Biomarker-Enhanced Scoring System for Lower Respiratory Tract Infections (OPTIMA I Basel)—An Observational Survey
AUTHORS:
Richard X. Sousa Da Silva, Frank Dusemund, Christian Nickel, Roland Bingisser, Andreas Huber, Beat Müller, Werner C. Albrich
KEYWORDS:
Lower Respiratory Tract Infection; Proadrenomedullin; Biomarker-Enhanced Disposition; CURb65-A-Score; Outpatient Treatment
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.2,
February
26,
2013
ABSTRACT: Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in
clinical routine. We therefore proposed an improved
CURB65 A score, supplemented by proadre nome dull in (ProADM)
levels for patients with CAP and other lower respiratory tract infections
(LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs
presenting to the emergency department of the University Hospital
of Basel. Methods: In this prospective observational cohort study
of 85 patients presenting with LRTIs, site of care was decided by the
physicians in charge according to their judgement. Retro spectively the CURB65 A score was
calculated and a virtual disposition assigned. This was compared with the
existing disposition in order to identify efficacy of the novel risk based
biomarker enhanced disposition. Results: The novel disposition criteria considered 14
patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be
best treated outside the hospital for nursing reasons, while the current
disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular
hospitalizations considerably (32 vs. 64, p 0.001). Conclusions: The novel
risk based biomarker enhanced disposition is an objective, safe and probably
more efficient disposition system to identify outpatient treatment options than
the current practice at the University Hospital of Basel.