A patient without an obvious need was defined as one who did not require endotracheal intubation and mechanical ventilation or as one who did not have hypotension requiring vasopressors while in the emergency department. Risk increases proportionally with the presence of more than three criteria.
Criteria for Consideration of ICU Admission for Patients without an Obvious Need
| Criterion | Definition |
| IDSA–ATS minor criteria | |
| Confusion | None specified |
| Elevated blood urea nitrogen | Blood urea nitrogen >/=20 mg/dl |
| Tachypnea | Respiratory rate >/=30 breaths/min |
| Multilobar infiltrates observed on radiograph | None specified |
| Hypoxemia | Ratio of partial pressure of oxygen in arterial blood to fraction of inspired oxygen <250 mm Hg |
| Thrombocytopenia | <100,000 platelets/mm3 |
| Hypotension | Hypotension (systolic pressure <90 mm Hg) requiring aggressive fluid resuscitation |
| Hypothermia | Core temperature of <36 °C |
| Leukopenia | White-cell count <4000/mm3 |
| Other criteria | |
| Lactic acidosis | Lactic acid level >/=4 mmol/liter |
| Low pH | <7.30–7.35, depending on scoring system* |
| Low albumin | <3.5 g/dl |
| Hyponatremia | Sodium level <130 mmol/liter |
| Leukocytosis | Leukocyte count >20,000/mm3 |
| Tachycardia | Heart rate >/=125 beats/min |
| Older age | >80 yr |
* The criterion of a pH level of less than 7.30 is used in the calculation of the CURXO score. The criterion of a pH level of less than 7.35 is used in the calculation of the SMART-COP and REA-ICU scores.
References:
- Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med. 2014 Feb 6;370(6):543-51. [Medline]
- Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, Wright AA, Ramirez JA, Christiansen KJ, Waterer GW, Pierce RJ, Armstrong JG, Korman TM, Holmes P, Obrosky DS, Peyrani P, Johnson B, Hooy M; Australian Community-Acquired Pneumonia Study Collaboration, Grayson ML. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008 Aug 1;47(3):375-84 [Medline]
- Renaud B, Labarère J, Coma E, Santin A, Hayon J, Gurgui M, Camus N, Roupie E, Hémery F, Hervé J, Salloum M, Fine MJ, Brun-Buisson C. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule. Crit Care. 2009;13(2):R54. [Medline]
- España PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, Bilbao A, Quintana JM. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006 Dec 1;174(11):1249-56. [Medline]
Created Mar 14, 2014.
