Editorial
PSI, CURB-65, SMART-COP or SCAP? And the winner is... SMART DOCTORS
PSI, CURB-65, SMART-COP ou SCAP? E o vencedor é... SMART DOCTORS
Filipe Froes
Pulmonary Consultant of the Intensive Respiratory Care Unit; Pulmonology Department of Centro Hospitalar Lisboa Norte, Lisboa, Portugal
Read
47706
Timeswas read the article
6292
Total PDF
41414
Total HTML
Share statistics
array:25 [ "pii" => "S0873215913001268" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.10.002" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "183" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Pneumol. 2013;19:243-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 28699 "formatos" => array:3 [ "EPUB" => 305 "HTML" => 25214 "PDF" => 3180 ] ] "itemSiguiente" => array:20 [ "pii" => "S0873215913000834" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.05.005" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "168" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:245-51" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9310 "formatos" => array:3 [ "EPUB" => 257 "HTML" => 7360 "PDF" => 1693 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>" "titulo" => "Cancro do pulmão no norte de Portugal: um estudo de base hospitalar" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "245" "paginaFinal" => "251" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Lung cancer in Northern Portugal: A hospital-based study" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1003 "Ancho" => 2946 "Tamanyo" => 194671 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolução dos cancros do pulmão registados (rácios em relação ao ano 2000).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Hespanhol, B. Parente, A. Araújo, J. Cunha, A. Fernandes, M.M. Figueiredo, R. Neveda, M. Soares, F. João, H. Queiroga" "autores" => array:10 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Hespanhol" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Parente" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Araújo" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cunha" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Fernandes" ] 5 => array:2 [ "nombre" => "M.M." "apellidos" => "Figueiredo" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Neveda" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Soares" ] 8 => array:2 [ "nombre" => "F." "apellidos" => "João" ] 9 => array:2 [ "nombre" => "H." "apellidos" => "Queiroga" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173511513000699" "doi" => "10.1016/j.rppnen.2013.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000699?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000834?idApp=UINPBA00004E" "url" => "/08732159/0000001900000006/v2_201509041406/S0873215913000834/v2_201509041406/pt/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0873215913001256" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2013.10.001" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "182" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "edi" "cita" => "Rev Port Pneumol. 2013;19:241-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4709 "formatos" => array:3 [ "EPUB" => 245 "HTML" => 3458 "PDF" => 1006 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Studies on lung cancer management in routine practice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "241" "paginaFinal" => "242" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Estudos sobre a abordagem clínica no cancro do pulmão" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jean-Paul Sculier" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Jean-Paul" "apellidos" => "Sculier" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913001256?idApp=UINPBA00004E" "url" => "/08732159/0000001900000006/v2_201509041406/S0873215913001256/v2_201509041406/en/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S0873215913000573" "issn" => "08732159" "doi" => "10.1016/j.rppneu.2012.09.006" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "159" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2013;19:252-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7851 "formatos" => array:3 [ "EPUB" => 282 "HTML" => 5947 "PDF" => 1622 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>" "titulo" => "Pneumonia pneumocócica – serão os novos scores mais precisos a prever eventos desfavoráveis?" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "252" "paginaFinal" => "259" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pneumococcal pneumonia – are the new severity scores more accurate in predicting adverse outcomes?" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1108 "Ancho" => 1625 "Tamanyo" => 88347 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Curva ROC para previsão de necessidade de admissão na UCI para cada <span class="elsevierStyleItalic">score</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Ribeiro, I. Ladeira, A.R. Gaio, M.C. Brito" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Ribeiro" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Ladeira" ] 2 => array:2 [ "nombre" => "A.R." "apellidos" => "Gaio" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Brito" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173511513000687" "doi" => "10.1016/j.rppnen.2013.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000687?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000573?idApp=UINPBA00004E" "url" => "/08732159/0000001900000006/v2_201509041406/S0873215913000573/v2_201509041406/pt/main.assets" ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "PSI, CURB-65, SMART-COP or SCAP? And the winner is... SMART DOCTORS" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "244" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Filipe Froes" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Filipe" "apellidos" => "Froes" "email" => array:1 [ 0 => "filipe.froes@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pulmonary Consultant of the Intensive Respiratory Care Unit; Pulmonology Department of Centro Hospitalar Lisboa Norte, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "PSI, CURB-65, SMART-COP ou SCAP? E o vencedor é... SMART DOCTORS" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Community-acquired pneumonia (CAP) is one of the most common diseases in adults with an estimated average annual incidence of 5 to 11 cases per 1000 inhabitants,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which increases significantly with age.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is a major cause of hospital admission but the percentage of patients hospitalized for CAP varies greatly depending on country or region, the populations studied and the way the health systems are organised. In Portugal, it is estimated that 25 to 50% of adults with CAP are admitted to hospital<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and, in the period from 2000 to 2009, CAP was one of the principle causes of hospitalization, representing 3,7% of total adult hospital admissions.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the majority of patients are treated as out-patients, hospital admissions for treatment of patients with CAP represent a big percentage of the cost of treating CAP patients. Studies carried out in the United States of America (USA), at the end of the last century, worked out that the total annual cost was 8,4 billion US dollars, of which 8,0 billion (95%) was the result of hospital admission.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> To deal with this, Michael Fine <span class="elsevierStyleItalic">et al</span> developed the first score for CAP, the <span class="elsevierStyleItalic">Pneumonia Severity Index</span> (PSI), with the goal of predicting mortality and identifying patients at low risk of mortality who did not need to be admitted to hospital.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The PSI stratifies patients into 5 risk classes, based on evaluation of more than twenty clinical and laboratory parameters, heavily weighted for age and comorbidities.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The complexity of the PSI, led to the development of another score, the CURB-65 (acronym for Confusion, Urea, Respiratory rate, Blood pressure and age ≥65) by the British Thoracic Society.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Various studies have evaluated the PSI and the CURB-65 in the same populations with comparable results for predicting mortality and identifying low-risk patients, although in one study the CURB-65 had better results in predicting mortality in the most serious cases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It should be pointed out that neither the PSI nor the CURB-65 were developed to identify patients needing to be referred to the Intensive Care Units (ICU), although the CURB-65 does appear to be more precise than the PSI in predicting admission to ICU.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In 2001, the American Thoracic Society (ATS) made the following recommendations for CAP in order to identify patients with serious pneumonia and predicted admission into ICU using major and minor criteria.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Severe CAP was defined by the presence of one of two major criteria (dependence on mechanical ventilation or septic shock) or 2 of three minor criteria (systolic blood pressure ≤90<span class="elsevierStyleHsp" style=""></span>mm Hg, multilobar involvement or PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> ≤250).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In 2007, joint recommendations by the Infectious Diseases Society of America (IDSA) and the ATS<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> increased the minor criteria to nine, patients needing to meet at least 3 minor criteria to be defined as severe CAP; however, there were no gains in terms of sensitivity or specificity over the 2001 criteria.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">More recently, two new scores have emerged: the SMART-COP (acronym for Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen and pH) developed in Australia,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and SCAP (Severe CAP) developed in Spain,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> which utilizes major criteria (pH and systolic blood pressure) and minor ones (confusion, urea, respiratory rate, multilobar infiltrates, oxygen and age ≥80). Although many of the parameters evaluated are common to all scores, these two new scores differ from the PSI and CURB-65 in that they do not present the same level of validation and their principle goal is identification of patients with severe pneumonia who need to be referred to ICU. In the actual PJP edition C. Ribeiro et al. compare these new scores with the two previous ones.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">15</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">All the existing scores have advantages and limitations. The main advantages are the prediction of risk of mortality and serious progressive complications, cutting down costs by reducing expensive hospital human resources on low-risk patients and in the early recognition of the most seriously ill patients so that they benefit from rapid referral to the ICU.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Another important advantage is the use of scores in clinical research.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In terms of limitations, the different scores vary in terms of levels of validation and accuracy, particularly among certain age groups, such as the oldest and the youngest. They do not properly take into account social factors and the degree of dependency which could affect the decision as to whether to admit to hospital and there is also the omission of important comorbidities like DPOC, immunosuppression and functional status. Very recently the Influenza A(H1N1) pandemic in 2009, provided the opportunity to check the lowest predictive value and usefulness of the different scores in patients with viral pneumonia.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">None of the current scores include acute phase inflammatory markers or biomarkers but preliminary data indicate that these, in particular procalcitonin, could improve the score risk stratification and thus increase their usefulness.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, these scores are useful tools but they cannot nor should they substitute medical evaluation and clinical reasoning. Ideally, the best strategic approach to CAP will always depend on experienced doctors (SMART-DOCTORS) who can apply their knowledge to the complexity and specific characteristics of the individual patients and can use the scores as supplementary information to make appropriate decisions for the population in question.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "BTS guidelines for the management of community acquired pneumonia in adults: update 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.S. Lim" 1 => "S.V. Baudouin" 2 => "R.C. George" 3 => "A.T. Hill" 4 => "C. Jamieson" 5 => "I. Le Jeune" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thx.2009.121434" "Revista" => array:7 [ "tituloSerie" => "Thorax" "fecha" => "2009" "volumen" => "64" "numero" => "Suppl 3" "paginaInicial" => "iii1" "paginaFinal" => "iii55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19783532" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of Community-Acquired Pneumonia in the Population of Four Municipalities in Eastern Finland" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Jokinen" 1 => "L. Heiskanen" 2 => "H. Juvonen" 3 => "S. Kallinen" 4 => "K. Karkola" 5 => "M. Korppi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "American Journal of Epidemiology" "fecha" => "1993" "volumen" => "137" "paginaInicial" => "977" "paginaFinal" => "988" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8317455" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Pneumonia in the adult population in continental Portugal - incidence and mortality in hospitalized patients from 1998 to 2000]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Froes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2003" "volumen" => "9" "paginaInicial" => "187" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14685629" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital admissions of adults with community-acquired pneumonia in Portugal between 2000 and 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Froes" 1 => "A. Diniz" 2 => "M. Mesquita" 3 => "M. Serrado" 4 => "B. Nunes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00216711" "Revista" => array:6 [ "tituloSerie" => "European Respiratory Journal" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "1141" "paginaFinal" => "1146" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878871" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The cost of treating community-acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.S. Niederman" 1 => "J.S. McCombs" 2 => "A.N. Unger" 3 => "A. Kumar" 4 => "R. Popovian" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Ther" "fecha" => "1998" "volumen" => "20" "paginaInicial" => "820" "paginaFinal" => "837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9737840" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Fine" 1 => "T.E. Auble" 2 => "D.M. Yealy" 3 => "B.H. Hanusa" 4 => "L.A. Weissfeld" 5 => "D.E. Singer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199701233360402" "Revista" => array:6 [ "tituloSerie" => "New England Journal of Medicine" "fecha" => "1997" "volumen" => "336" "paginaInicial" => "243" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8995086" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Making sense of scoring systems in community acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.S. Niederman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "327" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19353770" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.S. Lim" 1 => "M.M. van der Eerden" 2 => "R. Laing" 3 => "W.G. Boersma" 4 => "N. Karalus" 5 => "G.I. Town" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "377" "paginaFinal" => "382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12728155" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of a predictive rule for the management of community-acquired pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Capelastegui" 1 => "P.P. España" 2 => "J.M. Quintana" 3 => "I. Areitio" 4 => "I. Gorordo" 5 => "M. Egurrola" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00062505" "Revista" => array:6 [ "tituloSerie" => "European Respiratory Journal" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "151" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16387948" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the Management of Adults with Community-acquired Pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Niederman" 1 => "L.A. Mandell" 2 => "A. Anzueto" 3 => "J.B. Bass" 4 => "W.A. Broughton" 5 => "G.D. Campbell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.163.7.at1010" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "163" "paginaInicial" => "1730" "paginaFinal" => "1754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401897" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.A. Mandell" 1 => "R.G. Wunderink" 2 => "A. Anzueto" 3 => "J.G. Bartlett" 4 => "G.D. Campbell" 5 => "N.C. Dean" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2007" "paginaInicial" => "S27" "paginaFinal" => "S72" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe Community-Acquired Pneumonia: Validation of the Infectious Diseases Society of America/American Thoracic Society Guidelines to Predict an Intensive Care Unit Admission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Liapikou" 1 => "M. Ferrer" 2 => "E. Polverino" 3 => "V. Balasso" 4 => "M. Esperatti" 5 => "R. Piñer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/596307" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "377" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19140759" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.G.P. Charles" 1 => "R. Wolfe" 2 => "M. Whitby" 3 => "M.J. Fine" 4 => "A.J. Fuller" 5 => "R. Stirling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/589754" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "375" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18558884" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.P. España" 1 => "A. Capelastegui" 2 => "I. Gorordo" 3 => "C. Esteban" 4 => "M. Oribe" 5 => "M. Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200602-177OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2006" "volumen" => "174" "paginaInicial" => "1249" "paginaFinal" => "1256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16973986" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0085" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumonia pneumocócica – serão os novos scores mais precisos a prever eventos desfavoráveis?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Ribeiro" 1 => "I. Ladeira" 2 => "A.R. Gaio" 3 => "M.C. Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppneu.2012.09.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "252" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23850193" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severity of Influenza A 2009 (H1N1) Pneumonia Is Underestimated by Routine Prediction Rules. Results from a Prospective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Bjarnason" 1 => "G. Thorleifsdottir" 2 => "A. Löve" 3 => "J.F. Gudnason" 4 => "H. Asgeirsson" 5 => "K.L. Hallgrimsson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Population-Based Study PLoS ONE Public Library of Science" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e46816EP" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000001900000006/v2_201509041406/S0873215913001268/v2_201509041406/en/main.assets" "Apartado" => array:4 [ "identificador" => "9595" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Editoriais" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001900000006/v2_201509041406/S0873215913001268/v2_201509041406/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913001268?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 29 | 6 | 35 |
| 2024 October | 203 | 52 | 255 |
| 2024 September | 204 | 40 | 244 |
| 2024 August | 309 | 35 | 344 |
| 2024 July | 274 | 54 | 328 |
| 2024 June | 251 | 54 | 305 |
| 2024 May | 183 | 49 | 232 |
| 2024 April | 194 | 44 | 238 |
| 2024 March | 305 | 42 | 347 |
| 2024 February | 180 | 36 | 216 |
| 2024 January | 194 | 33 | 227 |
| 2023 December | 142 | 35 | 177 |
| 2023 November | 170 | 41 | 211 |
| 2023 October | 184 | 50 | 234 |
| 2023 September | 165 | 42 | 207 |
| 2023 August | 155 | 43 | 198 |
| 2023 July | 151 | 41 | 192 |
| 2023 June | 178 | 23 | 201 |
| 2023 May | 267 | 44 | 311 |
| 2023 April | 212 | 30 | 242 |
| 2023 March | 269 | 51 | 320 |
| 2023 February | 196 | 51 | 247 |
| 2023 January | 138 | 36 | 174 |
| 2022 December | 168 | 40 | 208 |
| 2022 November | 211 | 52 | 263 |
| 2022 October | 188 | 38 | 226 |
| 2022 September | 153 | 44 | 197 |
| 2022 August | 223 | 87 | 310 |
| 2022 July | 234 | 96 | 330 |
| 2022 June | 182 | 40 | 222 |
| 2022 May | 191 | 61 | 252 |
| 2022 April | 148 | 39 | 187 |
| 2022 March | 176 | 78 | 254 |
| 2022 February | 210 | 45 | 255 |
| 2022 January | 241 | 46 | 287 |
| 2021 December | 155 | 46 | 201 |
| 2021 November | 202 | 52 | 254 |
| 2021 October | 280 | 83 | 363 |
| 2021 September | 180 | 49 | 229 |
| 2021 August | 176 | 41 | 217 |
| 2021 July | 190 | 56 | 246 |
| 2021 June | 174 | 57 | 231 |
| 2021 May | 290 | 43 | 333 |
| 2021 April | 694 | 141 | 835 |
| 2021 March | 563 | 85 | 648 |
| 2021 February | 367 | 58 | 425 |
| 2021 January | 450 | 54 | 504 |
| 2020 December | 378 | 48 | 426 |
| 2020 November | 387 | 58 | 445 |
| 2020 October | 325 | 36 | 361 |
| 2020 September | 465 | 69 | 534 |
| 2020 August | 485 | 48 | 533 |
| 2020 July | 579 | 68 | 647 |
| 2020 June | 555 | 75 | 630 |
| 2020 May | 621 | 100 | 721 |
| 2020 April | 742 | 100 | 842 |
| 2020 March | 773 | 122 | 895 |
| 2020 February | 666 | 83 | 749 |
| 2020 January | 655 | 98 | 753 |
| 2019 December | 527 | 65 | 592 |
| 2019 November | 645 | 82 | 727 |
| 2019 October | 845 | 133 | 978 |
| 2019 September | 866 | 75 | 941 |
| 2019 August | 910 | 88 | 998 |
| 2019 July | 838 | 102 | 940 |
| 2019 June | 800 | 87 | 887 |
| 2019 May | 934 | 83 | 1017 |
| 2019 April | 681 | 114 | 795 |
| 2019 March | 705 | 79 | 784 |
| 2019 February | 428 | 39 | 467 |
| 2019 January | 462 | 57 | 519 |
| 2018 December | 163 | 7 | 170 |
| 2018 November | 54 | 2 | 56 |
| 2018 October | 65 | 10 | 75 |
| 2018 September | 250 | 9 | 259 |
| 2018 August | 468 | 37 | 505 |
| 2018 July | 422 | 36 | 458 |
| 2018 June | 236 | 28 | 264 |
| 2018 May | 290 | 35 | 325 |
| 2018 April | 294 | 42 | 336 |
| 2018 March | 318 | 22 | 340 |
| 2018 February | 195 | 22 | 217 |
| 2018 January | 234 | 24 | 258 |
| 2017 December | 199 | 24 | 223 |
| 2017 November | 227 | 31 | 258 |
| 2017 October | 199 | 26 | 225 |
| 2017 September | 203 | 36 | 239 |
| 2017 August | 274 | 21 | 295 |
| 2017 July | 239 | 43 | 282 |
| 2017 June | 265 | 50 | 315 |
| 2017 May | 271 | 31 | 302 |
| 2017 April | 237 | 14 | 251 |
| 2017 March | 468 | 44 | 512 |
| 2017 February | 468 | 8 | 476 |
| 2017 January | 205 | 12 | 217 |
| 2016 December | 293 | 20 | 313 |
| 2016 November | 290 | 25 | 315 |
| 2016 October | 351 | 16 | 367 |
| 2016 September | 351 | 44 | 395 |
| 2016 August | 231 | 62 | 293 |
| 2016 July | 126 | 32 | 158 |
| 2016 May | 2 | 20 | 22 |
| 2016 April | 240 | 5 | 245 |
| 2016 March | 273 | 65 | 338 |
| 2016 February | 261 | 64 | 325 |
| 2016 January | 207 | 40 | 247 |
| 2015 December | 168 | 43 | 211 |
| 2015 November | 243 | 43 | 286 |
| 2015 October | 269 | 50 | 319 |
| 2015 September | 268 | 60 | 328 |
| 2015 August | 252 | 32 | 284 |
| 2015 July | 352 | 38 | 390 |
| 2015 June | 201 | 44 | 245 |
| 2015 May | 286 | 45 | 331 |
| 2015 April | 289 | 36 | 325 |
| 2015 March | 320 | 36 | 356 |
| 2015 February | 396 | 25 | 421 |
| 2015 January | 345 | 23 | 368 |
| 2014 December | 298 | 26 | 324 |
| 2014 November | 362 | 31 | 393 |
| 2014 October | 366 | 42 | 408 |
| 2014 September | 329 | 48 | 377 |
| 2014 August | 304 | 38 | 342 |
| 2014 July | 241 | 26 | 267 |
| 2014 June | 235 | 16 | 251 |
| 2014 May | 254 | 28 | 282 |
| 2014 April | 169 | 46 | 215 |
| 2014 March | 206 | 46 | 252 |
| 2014 February | 160 | 49 | 209 |
| 2014 January | 133 | 55 | 188 |
| 2013 December | 94 | 39 | 133 |
| 2013 November | 134 | 48 | 182 |
Show all
