PSI/PORT Criteria
The PSI/ PORT Criteria is used to assess the risk of community acquired pneumonia and predict the need for hospitalization. Points are given for 20 risk factors, with the total number of points indicating the risk class and level of risk of getting pneumonia.
The total score can range from 1-130+ with risk classes I, II, III, IV, and V. A score of 70 or higher indicates a risk class II, 71-90 score indicate risk class III, 91-130 score indicate risk class of IV, and a score of 130+ indicate risk class of V.
This scoring system is intended to estimate mortality for adult patients with community-acquired pneumonia.
Calculation
A sum of points is calculated based on the presence of the following risk factors:
- Age:
1 point for each year of age
- Gender - Male:
0 points
- Gender - Female:
-10 points
- Nursing home resident:
10 points
- Neoplastic disease - coexisting illness:
30 points
- Liver disease - coexisting illness:
20 points
- Congestive heart failure - coexisting illness:
10 points
- Cerebrovascular disease - coexisting illness:
10 points
- Renal disease - coexisting illness:
10 points
- Altered mental status:
20 points
- Respiratory rate >= 30/min:
20 points
- Systolic blood pressure <90mm Hg:
20 points
- Temperature <35C or >= 40C:
15 points
- Pulse >= 125/min:
10 points
- Arterial pH < 7.35:
30 points
- Blood urea nitrogen >= 30mg/dL:
20 points
- Sodium < 130mEq/L:
20 points
- Glucose >= 250mg/dL:
10 points
- Hematocrit < 30%:
10 points
- Partial pressure of arterial oxygen < 60mm Hg:
10 points
- Pleural effusion:
10 points
Scoring
>=50 years old: risk class II or higher(depending on other risk factors) <=50 points: risk class I<=70 points: risk class II71-90 points: risk class III91-130 points: risk class IV>=130 points: risk class V
Considerations
- This score may be used to help guide the initial decision on site of care. However, its use may not be appropriate for all patients-specially those younger-therefore should be applied in conjunction with physician judgment.
- The PSI was developed prior to aggressive sepsis screening with lactate testing, thus consider sepsis in patients with pneumonia.
References
- Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243-50. doi: 10.1056/NEJM199701233360402. PMID: 8995086.
- https://archive.ahrq.gov/clinic/pneuclin.htm