Pedro J Marcos1, Marcos I Restrepo2, Francisco J González-Barcala3, Nilam J Soni2, Iria Vidal1, Pilar Sanjuàn4, Diego Llinares5, Lucía Ferreira-Gonzalez6, Carlos Rábade3, Isabel Otero-González1, Pedro Marcos7, Héctor Verea-Hernando1. 1. Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC), A Coruña, Spain. 2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, South Texas Veterans Health Care System, Audie L. Murphy VA Hospital, and University of Texas Health Science Center, San Antonio, Texas, USA. 3. Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain. 4. Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain. 5. Servicio de Medicina Interna, Hospital Universitario de A Coruña, A Coruña, Spain. 6. Servicio de Medicina Interna, Hospital Arquitecto Marcide, Area Sanitaria de Ferrol, A Coruña, Spain. 7. Servicio de Neumología, Complejo Hospitalario Universitario de Ourense, Ourense, Spain.
Abstract
BACKGROUND: The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. METHODS: An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. RESULTS: One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P<0.005). CONCLUSIONS: Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons. Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients.
BACKGROUND: The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. METHODS: An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. RESULTS: One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P<0.005). CONCLUSIONS: Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons. Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients.
Entities:
Keywords:
Community-acquired pneumonia (CAP); hospitalization; pneumonia severity index (PSI)
Authors: Forest W Arnold; Guy N Brock; Paula Peyrani; Eduardo L Rodríguez; Alejandro A Díaz; Paolo Rossi; Julio A Ramirez Journal: Respir Med Date: 2010-06-23 Impact factor: 3.415
Authors: M Woodhead; F Blasi; S Ewig; J Garau; G Huchon; M Ieven; A Ortqvist; T Schaberg; A Torres; G van der Heijden; R Read; T J M Verheij Journal: Clin Microbiol Infect Date: 2011-11 Impact factor: 8.067
Authors: Bertrand Renaud; Eva Coma; Jose Labarere; Jan Hayon; Pierre-Marie Roy; Hélène Boureaux; Fabienne Moritz; Jean François Cibien; Thomas Guérin; Emmanuel Carré; Armelle Lafontaine; Marie Pierre Bertrand; Aline Santin; Christian Brun-Buisson; Michael J Fine; Eric Roupie Journal: Clin Infect Dis Date: 2006-11-28 Impact factor: 9.079
Authors: G Choudhury; J D Chalmers; P Mandal; A R Akram; M P Murray; P Short; A Singanayagam; A T Hill Journal: Eur Respir J Date: 2011-03-15 Impact factor: 16.671
Authors: Drahomir Aujesky; Julie B McCausland; Jeff Whittle; D Scott Obrosky; Donald M Yealy; Michael J Fine Journal: Clin Infect Dis Date: 2009-11-15 Impact factor: 9.079