title: IDSA/ATS minor criteria aid pre-intensive care unit resuscitation in severe community-acquired pneumonia.
abstract: The effect of employing severity scores to identify severe community-acquired pneumonia (SCAP) cases for early aggressive resuscitation is unknown. Optimising pre-intensive care unit (ICU) care may improve outcomes in patients at risk of SCAP. We conducted a before-and-after study of patients classified into control and intervention groups (January 2004 to December 2007 and January 2008 to December 2010, respectively). Our intervention was two-pronged, using the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) minor criteria to identify SCAP for aggressive emergency department resuscitation. Patients with SCAP, defined as those with three or more IDSA/ATS minor criteria, were targeted. Differences in mortality, triage and compliance with emergency department resuscitation were compared between the groups. The hospital mortality rate was lower in the intervention versus the control group (5.7% versus 23.8%, p<0.001). On multivariate analysis, the intervention group was associated with lower mortality (OR 0.24, 95% CI 0.09-0.67). ICU admission rates decreased from 52.9% to 38.6% (p=0.008) and inappropriately delayed ICU admissions decreased from 32.0% to 14.8% (p<0.001). There was increased compliance with the aggressive resuscitation protocol after the intervention. A combined intervention, using a pneumonia score to identify those at risk of SCAP early and an aggressive pre-ICU resuscitation protocol may reduce mortality and ICU admissions.
authors.affiliation: Dept of Medicine, National University Health System, Singapore.
authors.forename: Hui Fang
authors.initials: HF
authors.lastname: Lim
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: Wang Jee
authors.initials: WJ
authors.lastname: Ngerng
authors.forename: Mei Ying
authors.initials: MY
authors.lastname: Chew
authors.forename: Tiong Beng
authors.initials: TB
authors.lastname: Sim
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mahadevan
authors.forename: Tow Keang
authors.initials: TK
authors.lastname: Lim
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000628:therapy*; D004635:Emergency Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D055552:Infectious Disease Medicine / Q000592:standards*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015272:Pulmonary Medicine / Q000592:standards*; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D012955:Societies, Medical; D014481:United States