title: Outcomes of early, late, and no admission to the intensive care unit for patients hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community-acquired pneumonia (CAP).
  
  
  METHODS
  This was a post hoc analysis of the original data from the Emergency Department Community-Acquired Pneumonia (EDCAP) and Pneumocom-1 prospective multicenter cohort studies of adult patients hospitalized with CAP. Propensity score-adjusted analysis was used to compare 28-day mortality and hospital length of stay (LOS) for 199, 144, and 2,215 patients with early (i.e., ICU admission on the day of emergency department [ED] presentation), late, and no ICU admission.
  
  
  RESULTS
  Unadjusted 28-day mortality rates were 13.1, 19.4, and 5.7% for early, late, and no ICU admissions, respectively (p < 0.001). After adjusting for quintile of propensity score, the odds of 28-day mortality were higher for late ICU admissions relative to early ICU admissions (odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.42 to 4.90), and no ICU admissions (OR = 3.40; 95% CI = 2.11 to 5.48), but did not differ between early and no ICU admissions (OR = 1.29; 95% CI = 0.79 to 2.09). The median hospital LOS was 10 days for early (interquartile range [IQR] = 7 to 18), 15 days for late (IQR 9 to 23), and 6 days (IQR 4 to 9) for no ICU admissions (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests that late but not early admission to the ICU is associated with higher 28-day mortality for patients hospitalized with CAP. Patients admitted to the ICU have longer hospital LOS in comparison to those managed on the wards, particularly if they are admitted late to the ICU.
authors.affiliation: Service d'urgence, AP-HP, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France. bertrand.renaud@hmn.aphp.fr
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Aline
authors.initials: A
authors.lastname: Santin
authors.forename: Eva
authors.initials: E
authors.lastname: Coma
authors.forename: Cécile
authors.initials: C
authors.lastname: Noyez
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.forename: José
authors.initials: J
authors.lastname: Labarère
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality*; D013997:Time Factors