RT Journal Article
SR Electronic
T1 Physician Judgment Is A Crucial Adjunct To Pneumonia Severity Scores In Low Risk Patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj01729-2010
DO 10.1183/09031936.00172910
A1 G. Choudhury
A1 J.D. Chalmers
A1 P. Mandal
A1 A.R. Akram
A1 M.P. Murray
A1 P. Short
A1 A. Singanayagam
A1 A.T. Hill
YR 2011
UL http://erj.ersjournals.com/content/early/2011/03/21/09031936.00172910.abstract
AB Our study investigates the reasons for hospitalization in patients with low-risk (CURB65 score 0–1) community acquired pneumonia (CAP), with a view to identify the potential for increasing outpatient management.As a part of a prospective observational study of CAP, we evaluated reasons for hospitalization in these low-risk patients.565 patients had low-risk CAP. 420 of these were admitted (>12 hours). 39.3% had additional markers of severity justifying admission. 29.5% of the admissions were required for further management that could not be provided rapidly in the community. 11.9% had unsafe social circumstances. 19.3% had no clinical reason justifying hospitalization.30-day mortality was increased in patients with additional severity markers (6.7%), significantly higher compared to 0% for patients awaiting investigations (p=0.009) and 0%, without a clear indication for hospitalization (p=0.04). In a logistic regression analysis, parameters associated with 30-day mortality were chronic cardiac co-morbidity (AOR 5.73 95% CI 1.52–21.6, p=0.01) acidosis (AOR 5.14, 95% CI 1.44–18.3, p=0.01), hypoxia (AOR 9.86, 95% CI 2.39–40.7, p=0.002) and multilobar chest x-ray shadowing (AOR 4.54, 95% CI 1.21–17.1, p=0.03),This study supports recommendations from international guidelines that pneumonia severity scores should be used as an adjunct to clinical judgment, while deciding hospitalization.