Prognostic assessment will be important in flu pandemic

doi:10.1136/bmj.332.7539.490-c

BMJ 2006;332:490-491 (25 February), doi:10.1136/bmj.332.7539.490-c

Letter

Prognostic assessment will be important in flu pandemic

The first 150 words of the full text of this article appear below.

EDITOR—As highlighted by Bonten and Prins, secondary pneumoniawill cause considerable problems in a flu pandemic.¹ Symptomsand signs, however, have low predictive value in diagnosingpneumonia.² As patients with secondary pneumonia are likelyto be sicker, prognostic assessment could support clinicians'judgment.

One potential predictive tool is CURB65, which has been validatedin communityacquired pneumonia and is recommended by the BritishThoracic Society.² This uses four bedside criteria (confusion,respiratory rate, blood pressure, and age) and one laboratorycriterion (urea) to determine a patient's risk of death. Inprimary care the urea component can be dropped with similarperformance.² During a pandemic, CURB65 could be used to targetinterventions such as neuraminidase inhibitors, antibiotics,and hospital assessment. Its use in flu infection warrants furtherinvestigation.

The British Thoracic Society recommends amoxicillin for patientswith community acquired pneumonia at low risk of death (CURB65= 0-1) and amoxicillin . . . [Full text of this article]

Gavin D Barlow, consultant in infectious diseases and medicine

Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Cottingham, North Humberside HU16 5JQ Gavin.Barlow@hey.nhs.uk