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Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection

  • Allison S. BloomEmail author
  • Sunil Suchindran
  • Julie Steinbrink
  • Micah T. McClainEmail author
Original Paper



A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however, less is known about the utility of clinical prediction scores for all-cause acute respiratory infection (ARI), especially in elderly subjects who are at increased risk of poor outcomes.


We retrospectively analyzed risk factors and outcomes of individuals ≥ 60 years of age presenting to the emergency department with a clinical diagnosis of ARI.


Of 276 individuals in the study, 40 had proven viral infection and 52 proven bacterial infection, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive clinical (and expanded research) workup. Patients who were older, had multiple comorbidities, or who had proven bacterial infection were more likely to require hospital and ICU admission. We identified a novel model based on 11 demographic and clinical variables that were significant risk factors for ICU admission or mortality in elderly subjects with all-cause ARI. As comparators, a modified PORT score was found to correlate more closely with all-cause ARI severity than a modified CURB-65 score (r, 0.54, 0.39). Interestingly, modified Jackson symptom scores were found to inversely correlate with severity (r, − 0.34) but show potential for differentiating viral and bacterial etiologies.


Modified PORT, CURB-65, Jackson symptom scores, and a novel ARI scoring tool presented herein all offer predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care.


Aging Respiratory infection Viral infection Pneumonia 



ASB received funding from the Eugene A. Stead Foundation and the Infectious Diseases Society of America. JS is funded through an NIAID-sponsored T32 Transplant ID Training Grant. MTM received support through the National Institute of Allergy and Infectious Diseases (NIAID), the Veterans Health Administration, the Claude D. Pepper Center, and the PRIME consortium [National Institute of Aging (NIA)].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to this work.

Supplementary material

15010_2019_1299_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Duke University School of MedicineDurhamUSA
  2. 2.Center for Applied Genomics and Precision Medicine, Department of MedicineDuke UniversityDurhamUSA
  3. 3.Division of Infectious DiseasesDuke University Medical CenterDurhamUSA
  4. 4.Durham Veteran’s Affairs Medical CenterDurhamUSA

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