[Clinical policy for management and risk stratification of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria].
To identify discrepancies between Pneumonia Severity Index (PSI) risk class and the conventional criteria for deciding the site of care we performed a prospective observational study on 229 patients hospitalized for community-acquired pneumonia. PSI classes and corresponding mortality rates were as following: class I, 41 patients (0%); class II, 20 (0%); class III, 58 (1.7%); class IV, 86 (8.1%); class V, 24 (33.3%). Overall, 119 patients (52%) who were hospitalized according to conventional criteria were assigned to low-risk classes (I-III). Among these low risk patients, 58 (49%) had complications as respiratory failure, pleural effusion, hypotension or shock; among remaining patients, no reasons for admission were found. This latter group deserves prospective evaluation in randomized studies comparing in-hospital versus outpatient management.
Divisione di Fisiopatologia Respiratoria, Arcispedale S. Anna, Azienda Ospedaliera-Universitaria, Ferrara. pts@unife.it
Stefano
S
Putinati
Licia
L
Ballerin
Marco
M
Piattella
Lucia
L
Ritrovato
Franco
F
Zabini
Alfredo
A
Potena
D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D003627:Data Interpretation, Statistical; D006760:Hospitalization; D006801:Humans; D010996:Pleural Effusion / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment