title: Admission via the emergency department in relation to mortality of adults hospitalised with community-acquired pneumonia: an analysis of the British Thoracic Society national community-acquired pneumonia audit.
abstract: OBJECTIVE
  To determine the association between 30-day inpatient mortality and route of admission to hospital, for adults with community acquired pneumonia (CAP).
  
  
  METHODS
  We studied 16 313 adults included in the British Thoracic Society (BTS) national CAP audit dataset. Comparisons were made between adults admitted via emergency departments (ED) with non-ED routes of admission, with regard to 30-day inpatient mortality. Secondary outcome measures were adherence to national CAP guidelines (time to first chest X-ray ≤4 h from admission; time to first antibiotic dose ≤4 h from admission; antibiotic choice; and antibiotic route of administration) by route of admission.
  
  
  RESULTS
  Of adults hospitalised with CAP, 75.6% were admitted via ED; these adults had a greater prevalence of comorbid illness and higher disease severity in comparison with non-ED admissions. Adjusted 30-day inpatient mortality was similar for ED versus non-ED route of admission (OR 1.10, 95% CI 0.96 to 1.25). Admissions via ED were associated with faster processes of care (time to chest X-ray ≤4 h, adjusted OR 3.39, 95% CI 2.79 to 4.12; time to first antibiotic ≤4 h, adjusted OR 1.62, 95% CI 1.42 to 1.84) and greater use of intravenous antibiotics regardless of disease severity (adjusted OR 1.58, 95% CI 1.43 to 1.74).
  
  
  CONCLUSIONS
  Adults with CAP admitted via EDs have more comorbid illness and greater disease severity compared to those admitted via non-ED routes. Following adjustment for these differences, 30-day inpatient mortality was not associated with route of admission.
authors: Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors: Chamira
authors: C
authors: Rodrigo
authors: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors: Tricia M
authors: TM
authors: Mckeever
authors: Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors: Mark
authors: M
authors: Woodhead
authors: British Thoracic Society, London, UK.
authors: Sally
authors: S
authors: Welham
authors: Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors: Wei Shen
authors: WS
authors: Lim
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality*; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010343:Patient Admission; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality*; D014852:Wales / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: pneumonia/infections; respiratory, pneumonia/infections