Clinical research studyLow-risk patients admitted with community-acquired pneumonia
Section snippets
Study sites
This study involved all 6 hospitals in the Edmonton area and one free-standing emergency department. This study was approved by the research ethics committee at the University of Alberta.
Development of pneumonia pathway
A multi-disciplinary team developed a comprehensive pathway for the management of community-acquired pneumonia.7 The pathway consisted of an admission guideline (which was not expected to be a substitute for the physician’s judgement),4 preprinted orders covering routine aspects of care, an algorithm for
Results
During the 2 years of the study, 3065 patients in risk classes I and II were evaluated in the emergency departments of the participating hospitals. Of these, 586 (19.1%) patients were admitted. The admitted and the ambulatory patients are compared in Table 1. The admitted patients were older, 46.5 years of age versus 42.9 years, and were more likely to be female.
There was a 2-fold variation in the admission rate of low-risk patients at the 6 hospitals, ranging from 14.8% to 29.3%. The latter
Discussion
The site of care (home, hospital ward, or intensive care unit) is probably the single most important decision in the management of patients with community-acquired pneumonia.12 There are now several prediction rules or algorithms available to help the physician make this choice by stratifying the patients into those who are at low risk for mortality.4, 5, 6 We found that 19% of patients in risk classes I and II were admitted to hospital, with almost half staying 5 days or more, and 20% suffered
Acknowledgments
We thank the following community-acquired pneumonia pathway nurses: JoAnne de Jager, Linda Gardner, Lynne Korobanik, Tammy Pfeiffer, Cynthia Proskow, Sue Marshall, Nancy Baker, Nan Horne, Fredrika Herbert, and Carol Mangan. The staff of the Epidemiology Coordinating and Research Centre carried out data management for the project.
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Cited by (48)
Community-acquired pneumonia
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Bacterial Pneumonia in Older Adults
2017, Infectious Disease Clinics of North AmericaSurveillance of the activity of solithromycin (CEM-101) against bacteria from respiratory tract infections
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2009, ChestCitation Excerpt :Accurately assessing the severity of pneumonia is the key to managing patients with CAP appropriately. Clinical care should be based on a broader set of medical outcomes than mortality alone.10,11 In this study, conducted in two large cohorts of patients hospitalized with CAP, the SCAP score is slightly more accurate than the widely used PSI and CURB-65 in predicting adverse outcomes in patients hospitalized with CAP and performed best for all four outcomes.
Supported by an independent research establishment grant from the Alberta Heritage Foundation for Medical Research and by grants in aid from Capital Health, Abbott Canada, Pfizer Canada, and Jannsen-Ortho Canada.