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Community-Acquired Pneumonia
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Pneumonia Severity Index (PSI)

Home > Risk Stratification: Site-of-Care Decisions > Pneumonia Severity Index (PSI)

The Pneumonia Severity Index, or PSI, is a validated risk stratification instrument which can help in identifying CAP patients who can safely be treated with outpatient antibiotics. 

Point values are given for a variety of clinical and laboratory parameters.  The PSI involves calculating a score, which places a given patient into one of 5 risk classes.  Classes I, II, and III are at low risk for death, and may be considered for outpatient treatment.  Risk classes IV and V should usually be hospitalized.

Access our online Pneumonia Severity Index calculator.

Download a PDA version of the PSI calculator.*


Demographic factors

Age (in years)


Men

Women
-10
Nursing home resident
+10
Coexisting illnesses
Neoplastic disease
+30
Liver disease
+20
Congestive heart failure
+10
Cerebrovascular disease
+10
Renal disease
+10
Findings on physical examination
Altered mental status
+20
Respiratory rate >= 30/min
+20
Systolic blood pressure <90 mm Hg
+20
Temperature <35ºC or >= 40ºC
+15
Pulse >= 125 beats/min
+10
Laboratory and radiographic findings
Arterial pH <7.35
+30
Blood urea mitrogen >= 30/mg/dl (11 mmol/liter)
+20
Sodium < 130 mmol/liter
+20
Glucose >= 250 mg/dl (14 mmol/liter)
+10

Hematocrit <30%

+10
Partial pressure of arterial oxygen < 60 mm Hg or oxygen saturation < 90%
+10
Pleural effusion
+10
   


Stratification of Risk Score
Risk
Risk Class
Score
Mortality
 
Low
I
Based on algorithm
0.1%

Outpatient
treatment

Low
II
<= 70
0.6%
Low
III
71-90
0.9%
Moderate
IV
91-130
9.3%

Hospital
admission

High
V
>130
27.0%


* Interactive tool from the Assessment of the Variation and Outcomes of Pneumonia: Pneumonia Patient Outcomes Research Team Final Report. AHRQ Publication No. 97-N009.



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