1. PHS / Department of General Practice Predicting severity of pneumonia in general practice: a meta- analysis of the CRB-65 criteria Maggie McNally, James Curtain, Kirsty O’Brien, Borislav D Dimitrov, and Tom Fahey Predicting severity of pneumonia in general practice: a meta- analysis of the CRB-65 criteria Maggie McNally, James Curtain, Kirsty O’Brien, Borislav D Dimitrov, and Tom Fahey Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

2. PHS / Department of General Practice Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 0 1 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% Likely suitable for home treatment Consider hospital referral Urgent hospital admission CRB-65: a clinical prediction rule

3. PHS / Department of General Practice Studies included in meta-analysis (n=14) studysettingparticipants Barlow et al 2007inpatients419 Bauer et al 2006outpatients + inpatients1959 Bont et al 2008outpatients314 Buising et al 2007emergency department740 Capelastegui et al 2006outpatients + inpatients1776 Chalmers et al 2008inpatients1007 Ewig et al 2009inpatients388406 Kruger et al 2008outpatients + inpatients1404 Man et al 2007inpatients1016 Menendez et al 2009inpatients447 Myint et al 2006inpatients192 Schaaf et al 2007inpatients105 Schuetz et al 2008emergency department373 Zuberi et al 2008inpatients137 TOTAL398295

4. PHS / Department of General Practice Statistical Methods Derivation study used as predictive model Results presented as ratio measurement: predicted deaths by CRB-65 rule observed deaths in validation study

5. PHS / Department of General Practice Results

6. PHS / Department of General Practice Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 01 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% CRB-65

7. PHS / Department of General Practice n= 1025 events = 0 (0%) RR 9.41 (CI 1.75 – 50.66) n= 65802 events = 1555 (2.4%) RR 0.70 (CI 0.42 – 1.18)

8. PHS / Department of General Practice Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 01 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% CRB-65

9. PHS / Department of General Practice n= 765 events = 12 (1.6%) RR 4.84 (CI 2.61 – 8.96) n= 283 137 events = 37 745 (13.3%) RR 0.91 (CI 0.71 – 1.17)

10. PHS / Department of General Practice Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 01 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% CRB-65

11. PHS / Department of General Practice n= 27 events = 5 (18.5%) RR 1.58 (CI 0.59 – 4.19) n= 47119 events = 16158 (34.3%) RR 1.01 (CI 0.87 – 1.16)

12. PHS / Department of General Practice Conclusions

13. PHS / Department of General Practice Confusion Respiratory rate ≥ 30/min Blood pressure (SBP≤ 90 or DBP≤60) Age ≥ 65 01 or 2 3 or 4 Low Risk mortality 1.2% Intermediate Risk mortality 8.13% High Risk mortality 31% Hospital Based Patients

14. PHS / Department of General Practice Community Based Patients General trend towards over-prediction However, –Low cohort numbers –Low event numbers

15. PHS / Department of General Practice Acknowledgements RCSI Research Institute Grainne McCabe, RCSI Library