Comparison between the Severity Scoring Systems A-DROP and CURB-65 for Predicting Safe Discharge from the Emergency Department in Patients with Community-Acquired Pneumonia

Abstract

Background. In most community-acquired pneumonia (CAP) treatment guidelines, the Pneumonia Severity Index (PSI) and CURB-65 are used as prognostic tools. Recently, simpler and more effective predictive tools for CAP treatment, such as the A-DROP scoring system, have been developed. However, no study has performed a comparative evaluation to identify the superior tool for predicting when patients can be discharged safely. Objectives. To compare the performances of A-DROP and CURB-65, simple predictive tools for CAP, based on 30-day death rates and 72-hour revisit rates for CAP following discharge from the emergency department (ED). Method. This single-center retrospective observational study enrolled patients who were at least 18 years old and diagnosed with CAP at the Songklanagarind Hospital ED from January 2015 to April 2021. Following a severity assessment using the A-DROP and CURB-65 scoring systems, the 30-day mortality rates and 72-hour revisit rates after discharge from the ED were compared. Results. A total of 408 patients were enrolled in this study. Six (1.47%) died within 30 days after presentation, whereas 29 (7.1%) returned to the ED within 72 hours after discharge. Most patients (72%) who revisited the ED were over the age of 65 years. The areas under the receiver operating characteristic curves for the prediction of 30-day mortality were 0.756 (95% confidence interval [CI]: 0.526–0.987) and 0.808 (95% CI: 0.647–0.970) for A-DROP and CURB-65, respectively. The areas under the receiver operating characteristic curves for the prediction of 72-hour revisit were 0.617 (95% confidence interval [CI]: 0.507–0.728) and 0.639 (95% CI: 0.536–0.743) for A-DROP and CURB-65, respectively. Conclusion. A-DROP and CURB-65 yield similar results and can be used to assess low-risk patients with CAP for discharge from the ED. Older patients, even those with low-risk scores, should be particularly considered for admission to a short-term observation unit or ward.