Pneumonia Severity Index (PSI / Fine Score / PORT Risk Class)
Calculate the Pneumonia Severity Index (PSI / PORT Score) to stratify 30-day mortality risk in community-acquired pneumonia and guide outpatient vs inpatient management.
Fine / PSI Score Calculator
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This calculator is for informational and educational purposes. Results should be interpreted with clinical judgment and local guidelines.
What is the Fine Score / Pneumonia Severity Index (PSI)?
The Pneumonia Severity Index (PSI), also known as the Fine Score or PORT Score, is a clinical prediction rule developed by Dr. Michael J. Fine and colleagues in 1997 for the Patient Outcomes Research Team (PORT). It stratifies patients with community-acquired pneumonia (CAP) into five risk classes (Risk Class I to V) based on 20 demographic, comorbid, physical examination, and laboratory/radiographic variables. The PSI accurately predicts 30-day mortality and is recommended by IDSA/ATS guidelines to identify low-risk patients (Risk Classes I–II) who can be safely treated in the outpatient setting, reducing unnecessary hospital admissions.
PSI / Fine Score = Sum of 20 clinical criteria. Risk Class I (No comorbid/lab risk): Outpatient (mortality 0.1%). Class II (≤ 70 pts): Outpatient (0.6%). Class III (71–90 pts): Outpatient/Brief observation (2.8%). Class IV (91–130 pts): Inpatient (8.2%). Class V (> 130 pts): ICU admission (29.2%).
When to Use the Fine / PSI Calculator
- Emergency department decision support for hospital admission vs home management in community-acquired pneumonia.
- Comparing with CURB-65 score: PSI is more detailed and better at identifying low-risk candidates for outpatient therapy.
PSI / Fine Score Point System Breakdown
PSI Total Points Calculation
PSI Points = Age + Gender + Comorbidities + Physical Exam + Lab/Radiographic Findings
Male, age 65 (+65) + CHF (+10) + RR ≥ 30 (+20) + BUN ≥ 30 (+20) = 115 points (Risk Class IV -> Inpatient).
Variables
Age & Sex (points)
Age in years (Men: +Age, Women: +Age − 10, Nursing Home resident: +10)
Comorbidities (points)
Neoplastic disease (+30), Liver disease (+20), CHF (+10), Cerebrovascular disease (+10), Renal disease (+10)
Physical Exam Findings (points)
Altered mental status (+20), RR ≥ 30 (+20), SBP < 90 (+20), Temp < 35°C or ≥ 40°C (+15), Pulse ≥ 125 (+10)
Laboratory & X-Ray Findings (points)
pH < 7.35 (+30), BUN ≥ 30 mg/dL (+20), Na < 130 mEq/L (+20), Glucose ≥ 250 mg/dL (+10), Hct < 30% (+10), PaO₂ < 60 mmHg or SpO₂ < 90% (+10), Pleural effusion (+10)
If patient is < 50 years old with NO comorbidities and NO abnormal physical exam findings, they automatically fall into Risk Class I.
PSI Risk Class & Admission Guidance Matrix
Guidelines per IDSA / ATS CAP Consensus Guidelines.
| Range | Classification | Health Risk |
|---|---|---|
| Risk Class I (No risk factors) | Very Low Risk (0.1% 30d mortality) | Outpatient treatment with oral antibiotics. |
| Risk Class II (≤ 70 pts) | Low Risk (0.6% 30d mortality) | Outpatient treatment. |
| Risk Class III (71–90 pts) | Moderate Risk (2.8% 30d mortality) | Outpatient or brief observation unit admission. |
| Risk Class IV (91–130 pts) | High Risk (8.2% 30d mortality) | Inpatient hospital admission. |
| Risk Class V (> 130 pts) | Severe Risk (29.2% 30d mortality) | Inpatient hospital admission / consider ICU. |
Social factors, inability to take oral medications, or severe hypoxemia may mandate admission regardless of low PSI class.
Limitations & Clinical Warnings
Complex calculation requiring blood gas/labs, making it slower than CURB-65 in busy ER settings.
Heavily weighted by age, which may underestimate severity in young patients with severe pneumonia.
Medical Disclaimer
Use clinical judgment alongside PSI score. Always evaluate social situation and oral intake ability.
References & Citations
- Fine MJ, Auble TE, Yealy DM, et al.. “A prediction rule to identify low-risk patients with community-acquired pneumonia”. New England Journal of Medicine. 1997. 336(4): 243–250. PMID: 8995086 | DOI: 10.1056/NEJM199701233360402
Medically Reviewed
Reviewed by CliniqWise Clinical Advisory Board — Pulmonology Panel · Last updated: 2026-08-27 · Next review: 2027-02-27
Common Questions About Fine / PSI Score Calculator
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