title: Deaths in risk classes I-III: a measure of quality of care in patients hospitalised with CAP?
abstract: All deaths occurring in patients with community-acquired pneumonia in risk classes I-III were reviewed as a quality-of-care measure. The immediate and underlying causes of death were classified according to the World Health Organization protocol. Eleven (1.8%) of the 608 low-risk patients died. Three of the patients did not have pneumonia, one of whom was admitted with atypical pulmonary oedema due to stenosis of a prosthetic heart valve. Failure to include chronic lung disease in the severity-of-illness scoring system resulted in misclassification of seven patients. The most common underlying causes of death were pulmonary fibrosis at 27%, chronic obstructive lung disease at 18% and cancer at 27%. Respiratory failure was the immediate cause of death in 64% of patients, cardiac causes in 27%, and pneumonia in 9%. To conclude, the review of deaths in patients at low risk for mortality is useful for monitoring the quality of care received by patients who require admission for the treatment of community-acquired pneumonia, and that the pneumonia-specific severity-of-illness scoring system results in misclassification of patients with chronic obstructive lung disease and pulmonary fibrosis.
authors.affiliation: Walter C. Mackenzie Health Sciences Center, 8440 112 St, Edmonton, AB, T6G 2B7, Canada. tom.marrie@ualberta.ca
authors.forename: T J
authors.initials: TJ
authors.lastname: Marrie
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality*; D003951:Diagnostic Errors; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology; D011658:Pulmonary Fibrosis / Q000150:complications; D011666:Pulmonary Valve Stenosis / Q000150:complications; D011787:Quality of Health Care; D012131:Respiratory Insufficiency / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index