TY - JOUR
T1 - Severity assessment for lower respiratory tract infections
T2 - Potential use and validity of the CRB-65 in primary care
AU - Francis, Nick A.
AU - Cals, Jochen W.
AU - Butler, Christopher C.
AU - Hood, Kerenza
AU - Verheij, Theo
AU - Little, Paul
AU - Goossens, Herman
AU - Coenen, Samuel
PY - 2012/3/1
Y1 - 2012/3/1
N2 - Aims: To explore the potential use of the CRB-65 rule (based on Confusion, Respiratory rate, Blood pressure and age >65 years) in adults with lower respiratory tract infection (LRTI) in primary care. Methods: Primary care clinicians in 13 European countries recorded antibiotic treatment and clinical features for adults with LRTI. Patients recorded daily symptoms. Multilevel regression models determined the association between an elevated CRB-65 score and prolonged moderately severe symptoms, hospitalisation, and time to recovery. Sensitivity analyses used zero imputation. Results: Respiratory rate and blood pressure were recorded in 22.7% and 31.9% of patients, respectively. A total of 2,690 patients completed symptom diaries. The CRB-65 could be calculated for 339 (12.6%). A score of ≥1 was not significantly associated with prolonged moderately severe symptoms (odds ratio (OR) 0.42, 95% CI 0.04 to 4.19) or hospitalisations (OR 3.12, 95% CI 0.16 to 60.24), but was associated with prolonged time to self-reported recovery when using zero imputation (hazard ratio (HR) 0.75, 95% CI 0.64 to 0.88). Conclusions: Respiratory rate and blood pressure are infrequently measured in adults with LRTI. We found no evidence to support using the CRB-65 rule in the assessment of LRTI in primary care. However, it is unclear whether it is of value if used only in patients where the primary care clinician suspects pneumonia.
AB - Aims: To explore the potential use of the CRB-65 rule (based on Confusion, Respiratory rate, Blood pressure and age >65 years) in adults with lower respiratory tract infection (LRTI) in primary care. Methods: Primary care clinicians in 13 European countries recorded antibiotic treatment and clinical features for adults with LRTI. Patients recorded daily symptoms. Multilevel regression models determined the association between an elevated CRB-65 score and prolonged moderately severe symptoms, hospitalisation, and time to recovery. Sensitivity analyses used zero imputation. Results: Respiratory rate and blood pressure were recorded in 22.7% and 31.9% of patients, respectively. A total of 2,690 patients completed symptom diaries. The CRB-65 could be calculated for 339 (12.6%). A score of ≥1 was not significantly associated with prolonged moderately severe symptoms (odds ratio (OR) 0.42, 95% CI 0.04 to 4.19) or hospitalisations (OR 3.12, 95% CI 0.16 to 60.24), but was associated with prolonged time to self-reported recovery when using zero imputation (hazard ratio (HR) 0.75, 95% CI 0.64 to 0.88). Conclusions: Respiratory rate and blood pressure are infrequently measured in adults with LRTI. We found no evidence to support using the CRB-65 rule in the assessment of LRTI in primary care. However, it is unclear whether it is of value if used only in patients where the primary care clinician suspects pneumonia.
KW - Cough
KW - CRB-65
KW - Lower respiratory tract infections
KW - Primary health care
KW - Prognosis
KW - Risk assessment
UR - http://www.scopus.com/inward/record.url?scp=84857947338&partnerID=8YFLogxK
U2 - 10.4104/pcrj.2011.00083
DO - 10.4104/pcrj.2011.00083
M3 - Article
C2 - 21938349
AN - SCOPUS:84857947338
SN - 1471-4418
VL - 21
SP - 65
EP - 70
JO - Primary Care Respiratory Journal
JF - Primary Care Respiratory Journal
IS - 1
ER -