Community-Acquired Pneumonia: Defining the Patient at Risk of Severe Illness and the Role of Mortality Prediction Models in Patient Management

One hundred years ago, Edward Wells addressed an issue that remains central to the management of the patient with community-acquired pneumonia (CAP). Are there clinical features that aid discrimination between those at increased risk of death and those who will have an uncomplicated clinical course? If so, are there steps that can be taken that might then prevent that death? In those 100 years, much research has been undertaken into the assessment of CAP severity. Wells’ question has now been widened into the identification of low-and high-severity patients for the application of different management strategies, and these have been assessed against a number of outcome measures, not just death. This document reviews this

research and describes whether this, together with the advances in management that have occurred, has provided an answer to Wells’ question.