TY - JOUR T1 - Community acquired pneumonia in the emergency department: Comparison of clinical indication to in-hospital treatment and severity scales predicting mortality JF - European Respiratory Journal JO - Eur Respir J VL - 40 IS - Suppl 56 SP - P2490 AU - Rodolfo Ferrari AU - Fabio Tumietto AU - Fabrizio Giostra AU - Sara Tedeschi AU - Mauro Bernardi AU - Pierluigi Viale AU - Mario Cavazza Y1 - 2012/09/01 UR - http://erj.ersjournals.com/content/40/Suppl_56/P2490.abstract N2 - Introduction Severity scoring systems (SSS) are used to predict risk, to help decisions about management strategies. The most notable scales in clinical use for Community acquired pneumonia (CAP) in the Emergency Department (ED) are CURB65 and CRB65Objective To analyze cases in which the clinical judgement to admit and treat in-hospital a Patient with CAP disagreed with the low risk profile established by SSSMaterials and methods Observational clinical study in the ED of a university teaching hospital, enrolling every adult Patient with CAP related hospitalization in 4 months period.Results 73 Patients were emergently admitted; 172 resulted in high-intermediate risk class according to SSS. We compared high-intermediate versus low risk groups. The first were higher in mortality, Ddimer, urea, creatinin, CK, CKMB, LDH, NTproBNP, dyspnoea, neurologic dysfunction, need for mechanical ventilation or management in High Dependency Unit; and lower in SpO2 and rate of antibiotic treatment previously started. When the decision to admit showed discordance between SSS risk profile and clinical judgement, some elements were often involved: social and welfare aspects, chronic diseases, previous treatment failure, laboratory abnormalities, respiratory failure, chest Xrays characteristics.Discussion In the ED, careful clinical judgement is still irreplaceable in decision and management processes, beyond the help routinely added by SSS. New studies will define which parameters to develop to increase the value of some pivotal aspects in the triage process of CAP in the ED, to focus on the real need for hospitalization in the single Patient. ER -