Validation of a Risk-Based Biomarker-Enhanced Scoring System for Lower Respiratory Tract Infections (OPTIMA I Basel)—An Observational Survey

Richard X. Sousa Da Silva, Frank Dusemund, Christian Nickel, Roland Bingisser, Andreas Huber, Beat Müller, Werner C. Albrich

Department of Emergency Medicine, University Hospital of Basel, Basel, Switzerland.
Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland.
Medical University Department of the University of Basel, Kantonsspital Aarau, Switzerland.

DOI: 10.4236/ijcm.2013.42014                

Abstract

Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in clinical routine. We therefore proposed an improved CURB65 A score, supplemented by proadre nome dull in (ProADM) levels for patients with CAP and other lower respiratory tract infections (LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs presenting to the emergency department of the University Hospital of Basel. Methods: In this prospective observational cohort study of 85 patients presenting with LRTIs, site of care was decided by the physicians in charge according to their judgement. Retro spectively the CURB65 A score was calculated and a virtual disposition assigned. This was compared with the existing disposition in order to identify efficacy of the novel risk based biomarker enhanced disposition. Results: The novel disposition criteria considered 14 patients suitable for outpatient treatment compared to 11 in the current disposition (p = 0.5). It detected 7 patients to be best treated outside the hospital for nursing reasons, while the current disposition detected only 1 patient requiring geriatric care (p = 0.09). Further, it decreased regular hospitalizations considerably (32 vs. 64, p < 0.001). Conclusions: The novel risk based biomarker enhanced disposition is an objective, safe and probably more efficient disposition system to identify outpatient treatment options than the current practice at the University Hospital of Basel.

Keywords

Lower Respiratory Tract Infection; Proadrenomedullin; Biomarker-Enhanced Disposition; CURb65-A-Score; Outpatient Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

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