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Severity Assessment of Lower Respiratory Tract Infection in Malawi: Derivation of a Novel Index (SWAT-Bp) Which Outperforms CRB-65

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  • Edmund Birkhamshaw
  • Catriona J Waitt
  • Michael Innes
  • Peter I Waitt

Abstract

Objective: To assess the validity of CRB-65 (Confusion, Respiratory rate >30 breaths/min, BP 65 years) as a pneumonia severity index in a Malawian hospital population, and determine whether an alternative score has greater accuracy in this setting. Design: Forty three variables were prospectively recorded during the first 48 hours of admission in all patients admitted to Queen Elizabeth Central Hospital, Malawi, for management of lower respiratory tract infection over a two month period (N = 240). Calculation of sensitivity and specificity for CRB-65 in predicting mortality was followed by multivariate modeling to create a score with superior performance in this population. Results: Median age 37, HIV prevalence 79.9%, overall mortality 18.3%. CRB-65 predicted mortality poorly, indicated by the area under the ROC curve of 0.649. Independent predictors of death were: Male sex, “S” (AOR 2.6); Wasting, “W” (AOR 6.6); non-ambulatory, “A” (AOR 2.5); Temp >38°C or

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  • Edmund Birkhamshaw & Catriona J Waitt & Michael Innes & Peter I Waitt, 2013. "Severity Assessment of Lower Respiratory Tract Infection in Malawi: Derivation of a Novel Index (SWAT-Bp) Which Outperforms CRB-65," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-6, December.
    • Handle: RePEc:plo:pone00:0082178
    DOI: 10.1371/journal.pone.0082178
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