A teaching hospital's experience applying the Pneumonia Severity Index and antibiotic guidelines in the management of community-acquired pneumonia.
OBJECTIVE
The Pneumonia Severity Index (PSI) was developed to predict mortality in community-acquired pneumonia (CAP). It has been prospectively validated to identify patients who are at low risk of death and thereby aid in the selection of patients for outpatient management. This study assessed the compliance of medical staff at a university teaching hospital with the use of the PSI and the PSI-based local antibiotic guidelines in admitted patients.


METHODS
This was a retrospective study of 137 consecutive adults admitted with a primary diagnosis of CAP between July and December 2003. Implementation of the PSI and local antibiotic guidelines occurred 4 months prior to the study period. The data collected included patient demographics, PSI parameters, patient outcomes, adherence and compliance with the PSI scoring process and local antibiotic guidelines.


RESULTS
Forty per cent of all CAP admissions were patients in PSI Class I to III. The compliance with scoring the PSI was low (45 out of 137 patients; 33%), as was the accuracy of the PSI scoring (26 out of 45 patients; 58%). Compliance with the local antibiotic guidelines was 87% in patients in whom the PSI was performed.


CONCLUSIONS
In admitted patients, non-adherence with the PSI admission guidelines was common. Compliance with scoring the PSI and its scoring accuracy was low. This may be due to a lack of awareness and its relative complexity. Further studies to identify potential barriers to compliance are warranted.
Lee
Richard Wai Wing
RW
Department of Respiratory and Sleep Medicine, The St George Hospital, Gray Street, Kogarah, Australia.
Lindstrom
Steven Terence
ST
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents