Management of Community-Acquired Pneumonia: An Observational Study in UK Primary Care

Management of Community-Acquired Pneumonia: An Observational Study in UK Primary Care

A study to assess the frequency of CRB65 scoring in patients diagnosed with community-acquired pneumonia (CAP) in primary care has been recently published in the Dove Press journal Pragmatic and Observational Research[1].

Community-acquired pneumonia (CAP) is a leading infectious cause of death worldwide.[2] CAP requires a severity assessment for diagnosis and treatment, particularly in hospital admission decisions. As an increased mortality rate is associated with a delay in admissions to the intensive care unit in severe CAP cases, it is critical that treatment is based on the severity of CAP to improve treatment outcomes. Both the British Thoracic Society (BTS) and the National Institute for Health and Care Excellence (NICE) recommend that the CRB65 scoring system to be used for this purpose due to its high levels of accuracy. The score assigns one score for each component of confusion, respiratory rate, blood pressure and age of 65 years or more, up to a maximum of 4. However, not much is known about the frequency of its use in primary care. We therefore aimed to investigate the frequency of CRB65 scoring system usage for CAP patients in primary care.

Primary care records from 2009 to 2016 were extracted from the OPCRD and episodes of CAP were identified from the records. Information about CRB65 scoring in each episode was then identified and described.  Trends of scoring over time and determinants of CRB65 conduct were also assessed.

A total of 4734 cases of CAP were considered to be eligible for the study. Results showed that the CRB65 scoring system was only used for 19 of the 4734 episodes of CAP (0.4%), during the initial consultation with primary care clinicians. It was also used for 14 of these episodes (0.3%) during a period of one month before the CAP diagnosis, and only for 1 episode over a period of one month after the diagnosis. Recording of individual components of the CRB65 scoring system was more common, with 96 episodes recorded measures of at least 3 of the 4 parameters . However, it was observed that the frequency of recording of CRB65 scores increased from 0.1% to 2.3% after its inclusion in NICE’s recommendation in December 2014.

In conclusion, the use of the CRB65 scoring system by primary care clinicians was found to be quite low despite guideline recommendations. Future studies may want to look at the feasibility of using CRB65 scores in primary care and examine any barriers that prevent its use.

This project fulfils Singapore’s requirement for qualifying research & development. Firstly, this project is based on a pre-specified objective to acquire new knowledge. While previous studies have examined the relationship between the use of CRB65 scores and patient mortality rates, this is the first study conducted in Singapore to discuss the frequency of its use in primary care settings. This project therefore brings forth novel and valuable information. It is also a systematic, investigative and experimental (SIE) study with a series of structured and planned research activities to answer the research question specified above.

The full article is available here.

  1. Launders, N., Ryan, D., Winchester, C., Skinner, D., Konduru, P. R., & Price, D. (2019). Management of community-acquired pneumonia: an observational study in UK primary care. Pragmatic and Observational Research, 10, 53–65. doi: 10.2147/por.s211198
  2. Restrepo, M. I., Faverio, P., & Anzueto, A. (2014). Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis, 26(2), 151-158. doi: 1097/QCO.0b013e32835ebc6d