Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines.
BACKGROUND
Many groups have developed guidelines to shorten hospital length of stay in pneumonia in order to decrease costs, but the length of time until a patient hospitalized with pneumonia becomes clinically stable has not been established.


OBJECTIVE
To describe the time to resolution of abnormalities in vital signs, ability to eat, and mental status in patients with community-acquired pneumonia and assess clinical outcomes after achieving stability.


METHODS
Prospective, multicenter, observational cohort study.


METHODS
Three university and 1 community teaching hospital in Boston, Mass, Pittsburgh, Pa, and Halifax, Nova Scotia.


METHODS
Six hundred eighty-six adults hospitalized with community-acquired pneumonia.


METHODS
Time to resolution of vital signs, ability to eat, mental status, hospital length of stay, and admission to an intensive care, coronary care, or telemetry unit.


RESULTS
The median time to stability was 2 days for heart rate (< or =100 beats/min) and systolic blood pressure (> or =90 mm Hg), and 3 days for respiratory rate (< or =24 breaths/min), oxygen saturation (> or =90%), and temperature (< or =37.2 degrees C [99 degrees F]). The median time to overall clinical stability was 3 days for the most lenient definition of stability and 7 days for the most conservative definition. Patients with more severe cases of pneumonia at presentation took longer to reach stability. Once stability was achieved, clinical deterioration requiring intensive care, coronary care, or telemetry monitoring occurred in 1% of cases or fewer. Between 65% to 86% of patients stayed in the hospital more than 1 day after reaching stability, and fewer than 29% to 46% were converted to oral antibiotics within 1 day of stability, depending on the definition of stability.


CONCLUSIONS
Our estimates of time to stability in pneumonia and explicit criteria for defining stability can provide an evidence-based estimate of optimal length of stay, and outline a clinically sensible approach to improving the efficiency of inpatient management.
Halm
E A
EA
Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA. ethanvhalm@smtplink.mssm.edu
Fine
M J
MJ
Marrie
T J
TJ
Coley
C M
CM
Kapoor
W N
WN
Obrosky
D S
DS
Singer
D E
DE
D000328:Adult; D001900:Boston; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000628:therapy; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D011014:Pneumonia / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors