RT Journal Article SR Electronic T1 Effects of using the 2007 IDSA/ATS minor criteria to manage severe community-acquired pneumonia JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 5045 VO 42 IS Suppl 57 A1 Hui Fang Lim A1 Jason Phua A1 Amartya Mukhopadhyay A1 Wang Jee Ngerng A1 Malcolm Mahadevan A1 Tow Keang Lim YR 2013 UL http://erj.ersjournals.com/content/42/Suppl_57/5045.abstract AB Background:Severe community-acquired pneumonia (SCAP) is associated with mortality rates as high as 50%. Delayed intensive care unit (ICU) admission is associated with increased mortality. Pneumonia severity scores may help in early identification of at-risk SCAP patients. This study aimed to evaluate the clinical impact of using the 2007 IDSA/ATS minor criteria in SCAP.Methods:We started using the minor criteria at the emergency department (ED) as a triage tool in 2008. In this cohort study, we categorized patients into control (2004 - 2007) and intervention arms (2008 - 2010). We defined SCAP as fulfilment of ≥3 minor criteria regardless of site of care. We compared the site of care, route of ICU admission and hospital mortality. Patients with ≤2 minor criteria but required ICU admission were evaluated separately.Results:There were 172 and 176 ICU admissions in the control and intervention arms respectively. The proportion of SCAP patients admitted to the ICU decreased from 52.9% to 38.6% (p=0008). Of those who required ICU admission, direct admissions increased from 39.6% to 61.8% (p=0.006). Hospital mortality decreased from 23.8% to 5.7% (p<0.001). Being in the control group was an independent predictor for mortality (OR 4.14, 95% CI 1.33 – 13.16, p=0.014).There were 65 and 63 patients with ≤2 minor criteria requiring ICU admission in the control and intervention arms; ICU admission rates were 18.5% and 46.0% respectively.ConclusionUse of the 2007 IDSA/ATS minor criteria for triage may increase direct ICU admissions and reduce mortality in at-risk SCAP patients. It may not result in treatment delay in patients with ≤2 minor criteria and may not increase ICU admission rates.