What are the IDSA/ATS criteria for determining the appropriate care setting in community-acquired pneumonia (CAP)?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

The IDSA/ATS criteria for severe community-acquired pneumonia (CAP) are composed of both major and minor criteria. Although the major criteria indicate clear need for ICU-level care, the minor criteria for defining severe CAP have been validated for the use of differentiating between patients requiring ward-level versus ICU-level care. [41, 36, 42]

These criteria are particularly helpful in identifying those patients who are appropriate for admission to the ICU but who do not meet the major criteria of requiring mechanical ventilation or vasopressor support.

The presence of three of the following minor criteria indicates severe CAP and suggests the likely need for ICU-level care:

  • Respiratory rate of 30 breaths or more per minute

  • Ratio of PaO2 to fraction of inspired oxygen (ie, PaO2/FiO2) of 250 or less

  • Need for noninvasive ventilation (bilevel positive airway pressure [BiPAP] or continuous positive airway pressure [CPAP])

  • Multilobar infiltrates

  • Confusion/disorientation

  • Uremia (BUN 20 mg/dL or greater)

  • Leukopenia (white blood cell [WBC] count less than 4000 cells/µL)

  • Thrombocytopenia (platelet count less than 100,000/µL)

  • Hypothermia (core temperature less than 36°C)

  • Hypotension requiring aggressive fluid resuscitation

The major criteria are as follows:

  • Invasive mechanical ventilation

  • Septic shock requiring vasopressor support


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