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Deaths in risk classes I–III: a measure of quality of care in patients hospitalised with CAP?

CORRESPONDENCE: T.J. Marrie, 2F1.30 Walter C. Mackenzie Health Sciences Center, 8440 – 112 St, Edmonton, AB, T6G 2B7, Canada. Fax: 1 7804073132. E-mail: tom.marrie@ualberta.ca

Keywords: low risk, mortality, pneumonia, quality of care

Received: June 25, 2003
Accepted August 16, 2003

This work was supported by grants-in-aid from Capital Health Authority (Edmonton, AB), Pfizer Canada, Jannsen Ortho Canada, and Abbot Canada (Montreal, QC), and also by an establishment grant from Alberta Heritage Foundation for Medical Research, Edmonton, AB, Canada.

All deaths occurring in patients with community-acquired pneumonia in risk classes I–III were reviewed as a quality-of-care measure. The immediate and underlying causes of death were classified according to the World Health Organization protocol. Eleven (1.8%) of the 608 low-risk patients died. Three of the patients did not have pneumonia, one of whom was admitted with atypical pulmonary oedema due to stenosis of a prosthetic heart valve. Failure to include chronic lung disease in the severity-of-illness scoring system resulted in misclassification of seven patients.

The most common underlying causes of death were pulmonary fibrosis at 27%, chronic obstructive lung disease at 18% and cancer at 27%. Respiratory failure was the immediate cause of death in 64% of patients, cardiac causes in 27%, and pneumonia in 9%.

To conclude, the review of deaths in patients at low risk for mortality is useful for monitoring the quality of care received by patients who require admission for the treatment of community-acquired pneumonia, and that the pneumonia-specific severity-of-illness scoring system results in misclassification of patients with chronic obstructive lung disease and pulmonary fibrosis.