Pneumonia - severity assessment
These are guidelines only and management may vary depending on individual circumstances eg. An advanced care plan to avoid acute admissions.
Symptoms of an acute lower respiratory tract illness (cough and at least one other lower respiratory tract symptom)
New focal chest signs on examination
At least one systemic feature (either a symptom complex of sweating, fevers, shivers, aches and pains and/or temperature of 38°C or more).
No other explanation for the illness.
Chest x-ray should not be used routinely for patients with acute symptoms of community acquired pneumonia but should be considered in failure to respond to treatment or after about 6 weeks in patients with persistent signs or symptoms or who are at higher risk of malignancy eg. Age>50 or smokers.
Sputum culture is not recommended routinely for those managed in the community but should be considered if failure to respond to treatment.
Assessment of severity
Management is based on the assessment of severity of the pneumonia based on clinical judgement.
Pulse oximetry should be performed. SpO2 <92% may indicate need for admission.
The CRB-65 score is an aid to clinical judgement:
Score 1 point for each of:
Confusion of recent onset
Respiratory rate ≥ 30 per minute
Low systolic BP (<90mmHg) or low diastolic BP(≤60mmHg)
Age 65 or over
For patients admitted to hospital with pneumonia that is felt to be life-threatening the general practitioner should give benzylpenicillin 1.2g iv or amoxicillin 1g po whilst awaiting transfer unless penicillin allergic.