title: Community-acquired pneumonia--which patients are hospitalised?
abstract: OBJECTIVE
  Patients with community-acquired pneumonia can be allocated into low and high-risk mortality groups by simple clinical criteria. We studied the value of the stratification for outcome as proposed by Fine, et al. to guide the decision for in-hospital versus outpatient treatment in the emergency department.
  
  
  METHODS
  We studied demographic data, risk group stratification and decision-making for in-hospital versus outpatient treatment in 101 consecutive medical emergency department patients with community-acquired pneumonia. We also analysed predictive factors for hospitalisation of low-risk patients. We obtained complete 30 day follow-up information.
  
  
  RESULTS
  Forty-three of 44 high-risk patients were hospitalised after medical emergency department triage. Twenty-seven (47%) of 57 low-risk patients were hospitalised as well. Based on routine clinical assessment, hospitalisation of low-risk patients was required for poor medical condition or severe pneumonia (67%), for lack of social support (15%) and for relevant comorbidity (18%). In an univariate analysis, age (p = 0.003), C-reactive protein (p = 0.0006), presence of comorbidity (p = 0.0001), Charlson index (p = 0.0001) and active oral steroid treatment (p = 0.028) were significantly correlated with hospitalisation of low-risk patients. The 30-day mortality rate was 32% in patients allocated to the high-risk group at the time of diagnosis in the emergency department, compared to 0% in low-risk patients.
  
  
  CONCLUSIONS
  Simple clinical criteria distinguish well between low and high 30-day-mortality risk in patients diagnosed with community-acquired pneumonia. Nevertheless, 47% of low-risk patients require in-hospital treatment. Age, C-reactive protein, presence of comorbidity and steroid treatment are significantly correlated with hospitalisation of low-risk patients with community-acquired pneumonia.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: S P
authors.initials: SP
authors.lastname: Stäuble
authors.forename: S
authors.initials: S
authors.lastname: Reichlin
authors.forename: T
authors.initials: T
authors.lastname: Dieterle
authors.forename: B
authors.initials: B
authors.lastname: Leimenstoll
authors.forename: R
authors.initials: R
authors.lastname: Schoenenberger
authors.forename: B
authors.initials: B
authors.lastname: Martina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000401:mortality / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors