KRITERIA RAWAT
COMMUNITY ACQUIRED PNEUMONIA
Apakah pasien Community Acquired Pneumonia (CAP) harus dirawat
inap ? Untuk mengidentifikasi pasien CAP yang memerlukan rawat inap atau rawat
jalan dapat digunakan kriteria seperti CURB-65 dan PSI (Strong recommendation;level I evidence.)
1.
CURB-45
Kriteria CURB-65 (Confusion, Uremia, Respiratory rate, low Blood pressure, age > 65 years) merupakan salah satu pedoman
untuk identifikasi penderita CAP yang dirancang berdasarkan tingkat keparahan
penyakit . Kriteria ini lebih praktis digunakan di unit gawat darurat. Versi
sederhananya yaitu CRB-65 (minus Uremia) dapat dipergunakan bila pemeriksaan
darah belum dapat dilakukan atau pada praktek dokter sehari-hari.
TABEL
1. SKOR CURB-65
Clinical factors
|
Points
|
Confusion
|
1
|
Blood urea nitrogen > 19 mg/dL
|
1
|
Respiratory rate > 30
x/minute
|
1
|
Systolic blood pressure < 90 mmHg
Or
Diastolic blood pressure <
60 mmHg
|
1
|
Age > 65 years
|
1
|
Total Points
|
Sumber : Ebell Mh., Family Practice Management, 2006
TABEL 2. INTERPRETASI CURB-65 / CRB-65
CURB-65 score
|
Deaths/total (%)
|
Recommendation
|
0
|
7/1,223 (0,6)
|
Low risk; consider home treatment
|
1
|
31/1,142 (2,7)
|
|
2
|
69/1,019 (6,8)
|
Short inpatient hospitalization or closely supervised outpatient
treatment
|
3
|
79/563 (14,0)
|
Severe pneumonia; hospitalize and consider admitting to intensive care
|
4 or 5
|
44/158 (27,8)
|
CRB-65 score
|
Deaths/total (%)
|
Recommendation
|
0
|
2/212 (0,9)
|
Very low risk of death; usually does not require hospitalization
|
1
|
18/344 (5,2)
|
Increased risk of death; consider hospitalization
|
2
|
30/251 (12,0)
|
|
3 or 4
|
39/125 (31,2)
|
High risk of death; urgent hospitalization
|
Sumber : Ebell Mh., Family Practice Management, 2006
2. PSI
Pneumonia Severity
Index (PSI) mencakup 20 variabel, sehingga kurang praktis penggunaannya terutama
dalam unit gawat darurat. PSI memilah
pasien menjadi 5 kelas risiko kematian.
Tabel 3. SKOR PSI
Risk
Factor
|
Points
|
Demographics
|
|
Men
|
Age (years) : ____
|
Women
|
Age (years) – 10 : ____
|
Nursing home resident
|
+ 10
|
Comorbidities
|
|
Neoplasm
|
+ 30
|
Liver disease
|
+ 20
|
Heart failure
|
+ 10
|
Stroke
|
+ 10
|
Renal failure
|
+ 10
|
Physical
examination findings
|
|
Altered mental status
|
+ 20
|
Respiratory rate > 30 breaths per minute
|
+ 20
|
Systolic blood pressure < 90 mmHg
|
+ 20
|
Temperature < 95⁰F (35⁰C) or > 104⁰F
(40⁰C)
|
+ 15
|
Pulse rate > 125 beats per minute
|
+ 10
|
Laboratory
and radiographic findings
|
|
Arterial pH < 7,35
|
+ 30
|
Blood urea nitrogen > 30 mg/dL
|
+ 20
|
Sodium < 130 mmol/L
|
+ 20
|
Glucose > 250 mg/dL
|
+ 10
|
Hematocrit 30 percent
|
+ 10
|
Partial pressure of arterial oxygen < 60 mmHg
|
+ 10
|
Pleural effusion
|
+ 10
|
Total
points
|
|
Sumber : Ebell Mh., Family Practice Management, 2006
TABEL
4. INTERPRETASI PSI
Deaths/total (%)
|
||||
Point total
|
Risk class
|
Adults with CAP
|
Nursing home patients with CAP
|
Recommendation
|
< 51
|
I
|
3/1,472 (0,2)
|
None
|
Outpatient therapy should be
considered, especially for patients in classes I and II
|
51 to 70
|
II
|
7/1,374 (0,5)
|
None
|
|
71 to 90
|
III
|
41/1,603 (2,6)
|
1/21 (4,8)
|
|
91 to 130
|
IV
|
149/1,605 (9,3)
|
6/50 (12,0)
|
Patient should be hospitalized
|
>130
|
V
|
109/438 (24,9)
|
28/85 (32,9)
|
|
Sumber : Ebell Mh., Family Practice Management, 2006
REFERENSI :
Ebell MH. Outpatient vs.
Inpatient Treatment of Community Acquired Pneumonia. Family
Practice Management. April 2006:41-44;
http://www.aafp.org/fpm/20060400/41outp.html.
Mandell LA, Wunderink RG, Anzueto A, et al.
Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management
of Community-Acquired Pneumonia in Adults. Clinical Infectious
Diseases. 2007; 44:S27–72
