PSI / PORT Score Calculator
Pneumonia Severity Index — the most accurate tool for stratifying community-acquired pneumonia and safely identifying low-risk patients for outpatient management. Derived by the PORT Investigators (NEJM 1997).
Comorbidities
Examination findings
Labs / Imaging
Enter age to calculate score.
Safely send more low-risk pneumonia patients home
PSI Class I–II patients have <1% mortality and can be treated at home — yet 30–40% are unnecessarily admitted because the score takes too long to calculate manually. EasyClinic auto-computes PSI in real-time and prints the discharge instructions in Hindi/Tamil/Telugu/Bengali.
Also Known As
What is the PSI / PORT Score?
The Pneumonia Severity Index (PSI), also called the PORT score (Pneumonia Outcomes Research Team), is a validated risk-stratification tool for community-acquired pneumonia (CAP). Developed by Fine et al. (NEJM 1997) from a derivation cohort of 14,199 patients, it classifies patients into 5 risk classes (I–V) using 20 variables across demographics, comorbidities, vital signs, and labs.
It is the most accurate tool for identifying truly low-risk patients (Class I–II, mortality < 1%) who can be safely managed as outpatients — a key recommendation of the IDSA/ATS 2019 guideline.
PSI Class → Mortality → Disposition
- Class I: 0.1% mortality — Outpatient
- Class II (≤ 70 pts): 0.6% — Outpatient
- Class III (71–90 pts): 0.9% — Short observation / outpatient with close follow-up
- Class IV (91–130 pts): 9.3% — Inpatient ward
- Class V (> 130 pts): 27% — Inpatient, strongly consider ICU
How to use it (Step 1 — Class I shortcut)
Before tallying points, check the Class I criteria. A patient qualifies for Class I (no calculation needed) if ALL of these are true:
- Age ≤ 50 years
- No coexisting illnesses (cancer, CHF, CVD, renal, liver)
- Normal mental status
- Normal vital signs (no tachypnea, tachycardia, hypotension, hypo/hyperthermia)
ICS India + ICMR 2022 Empirical Antibiotics
- Class I–II (outpatient): Amoxicillin 1g TDS × 5d (~₹60) ± Azithromycin 500mg OD × 3d (~₹50). Doxycycline 100mg BD × 5d (~₹40) is a cheap atypical-cover alternative.
- Class III (short-stay): Co-amoxiclav 1.2g IV TDS (~₹270/day) + Azithromycin 500mg IV/PO (~₹250/dose IV).
- Class IV (ward): Ceftriaxone 2g IV OD (~₹120/day) + Azithromycin. Step-down to oral at 48–72h if afebrile and tolerating PO.
- Class V (ICU): Piperacillin-tazobactam 4.5g Q8H (~₹1,350/day) or Cefepime + Azithromycin; add Vancomycin (~₹600/day) for MRSA risk. Consider influenza/MTB/COVID co-testing.
- Course duration: 5 days for mild–moderate CAP if clinically improving; 7–14 days for severe/bacteremic/S. aureus/Pseudomonas.
PSI vs CURB-65 — which to use?
PSI is the gold standard for identifying truly low-risk patients (high negative predictive value). Its main downside is the 20-variable complexity.
CURB-65 uses only 5 variables and is faster at the bedside. It is comparable to PSI for identifying high-risk patients but less granular at the low-risk end.
Most Indian academic centers use PSI at admission and CURB-65 as a quick OPD/ED triage tool. The IDSA/ATS 2019 guideline prefers PSI.
Frequently Asked Questions
▸Do I need an ABG to calculate PSI?
Not strictly. The pH item adds 30 points but only matters in critically ill patients (who are obviously Class V anyway). SpO₂ < 90% on pulse oximetry substitutes for PaO₂ < 60 mmHg. Indian wards without ABG can still use PSI accurately.
▸My patient is PSI Class II (low risk) but lives alone and has no transport — admit?
Yes. PSI does NOT account for social factors. The IDSA/ATS 2019 guideline explicitly states that inability to take oral medication, lack of supervision, or unstable home situation are valid reasons to admit a low-PSI patient.
▸Does PSI work for Indian patients?
Yes — PSI has been validated in Asian and Indian cohorts (Singh et al. Indian J Chest Dis 2013). However, atypical pathogens (Mycoplasma, Chlamydia) and TB are more prevalent in India, so always cover atypicals with a macrolide/doxycycline and consider sputum AFB.
▸Why not just use CURB-65 — it is simpler?
CURB-65 misses some low-risk patients (false-positive admissions) and is less granular. If your goal is to safely discharge from the ED, PSI is more accurate. If your goal is rapid triage in a busy OPD, CURB-65 is faster.
▸How does PSI compare to SMART-COP?
SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS), not just mortality — making it more useful for ICU triage. PSI predicts mortality and is better for outpatient decisions. Many EDs calculate both.
References
- Fine MJ et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336(4):243-50
- Metlay JP et al. IDSA/ATS Clinical Practice Guideline on Community-Acquired Pneumonia. Am J Respir Crit Care Med 2019;200(7):e45-e67
- Indian Chest Society + NCCP Consensus Guidelines on Community-Acquired Pneumonia, 2012
- ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes, 2022
- Aujesky D et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005
The PSI score, in one click — not 5 minutes of arithmetic
EasyClinic pulls age, sex, comorbidities, vitals, ABG/SpO₂, electrolytes, and the X-ray report straight from the chart, calculates PSI + CURB-65 + SMART-COP simultaneously, and writes the right ICS-India antibiotic onto the prescription with chemist MRP.
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