Validity of pneumonia severity assessment scores in Africa and South Asia: a systematic review and meta-analysis

Al Hussain, S. K., Kurdi, A., Abutheraa, N., AlDawsari, A., Sneddon, J., Godman, B. and Seaton, R. A. (2021) Validity of pneumonia severity assessment scores in Africa and South Asia: a systematic review and meta-analysis. Healthcare, 9(9), 1202. (doi: 10.3390/healthcare9091202)

Abstract

Background: Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia). Methods: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores’ performance in predicting mortality. Results: Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25–0.94) and 0.96 (95% CI = 0.49–1.00), and for CRB-65, 0.09 (95% CI = 0.01–0.48) and 0.93 (95% CI = 0.50–0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73–0.96) and 0.64 (95% CI = 0.45–0.79), and for CRB-65, 0.99 (95% CI = 0.95–1.00) and 0.43 (95% CI = 0.24–0.64). Conclusions: CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).

• Item Type: Articles
• Keywords: Community-acquired pneumonia, severity of illness index, developing countries, mortality, prognosis, systematic review, meta-analysis.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Seaton, Dr Andrew

Creator Roles

Seaton, R. A.: Writing – review and editing

• Authors: Al Hussain, S. K., Kurdi, A., Abutheraa, N., AlDawsari, A., Sneddon, J., Godman, B., and Seaton, R. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Healthcare
• Publisher: MDPI
• ISSN: 2227-9032
• ISSN (Online): 2227-9032
• Published Online: 11 September 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Healthcare 9(9): 1202
• Publisher Policy: Reproduced under a Creative Commons License