Alternate Site of Care Program
Risk Stratification
The following tables provide risk stratification examples for home infusion for Community Acquired Pneumonia and Cellulitis.
Community Acquired Pneumonia
| Characteristic |
Points* |
Demographics |
|
Male |
+10 |
|
Nursing home patient |
+10 |
Coexisting Illness |
|
Neoplasm |
+30 |
|
Liver disease |
+20 |
|
Chronic Heart Failure |
+10 |
|
CVA |
+10 |
|
Renal disease |
+10 |
Physical Examination |
|
Altered mental status |
+20 |
|
Respiratory rate ≥ 30 breaths/minute |
+20 |
|
Systolic BP < 90mm Hg |
+20 |
|
Temperature < 35º C (95º F) or
≥ 40º C (104º F) |
+15 |
|
Pulse rate ≥ 125 beats/minute |
+10 |
Laboratory |
|
Arterial pH < 7.35 |
+30 |
|
BUN ≥ 30 mg/dL |
+20 |
|
Sodium < 130 mmol/L |
+20 |
|
Glucose ≥ 250 mg/dL |
+10 |
|
Hematocrit < 30% |
+10 |
|
PO2 < 60 mm Hg |
+10 |
|
| Pleural effusion |
+10 |
* Total points are calculated for each patient and a class is assigned:
| Class: |
Points: |
Risk Level: |
|
I |
0 |
Low Risk- Mortality 0.1% |
|
II |
≤70 |
Low Risk-Mortality 0.6% |
|
III |
71-90 |
Low Risk- Mortality 2.8% |
|
IV |
91-130 |
Moderate Risk- Mortality 8.2% |
|
V |
>130 |
High Risk- Mortality 29.2% |
Pneumonia Severity Index (PSI)
Cellulitis
Class II patients are appropriate for home infusion.
| Class |
Criteria |
I |
Healthy patients with cellulitis < 15cm in diameter,
with or without fever |
|
II |
Healthy patients or patients with peripheral vascular disease, diabetes, or obesity with cellulitis >15 cm, with or without fever; patients in whom oral antibiotics have failed |
|
III |
Patients with fever and mental status changes; physical findings of gangrene, crepitus bullae, or open draining wounds |
|
IV |
Patients with systemic complications of severe infection, which include, for example, hypotension, renal failure, and acute respiratory distress syndrome |
Eron/Dall Classification System for Cellulitis
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