title: Validating hospital admission criteria for decision support in pneumonia.
abstract: BACKGROUND
  We evaluated our previously derived admission criteria for agreement with physician decisions and outpatient failure among patients presenting to emergency departments (EDs) with pneumonia.
  
  
  METHODS
  Among patients presenting to seven Intermountain EDs in the urban region of Utah with pneumonia December 1 2009-December 1 2010, we measured hospital admission rates and outpatient failure, defined as either 7-day secondary hospitalization or death in 30 days for patients initially discharged home from the ED. We measured our admission criteria's ability to predict hospital admission and its hypothetical rates of admission and outpatient failure with strict adherence to the criteria. We compared our admission criteria to other electronically calculable criteria, CURB-65 and A-DROP.
  
  
  RESULTS
  In 2,308 patients, admission rate was 57%, 30-day mortality 6.1%, 7-day secondary hospitalization 5.8%, and outpatient failure rate 6.4%. Our admission criteria predicted hospital admission with an AUC of 0.77, compared to 0.73 for CURB-65 ≥ 2 and 0.78 for A-DROP ≥ 2. Hypothetical 100% concordance with our admission criteria decreased the hospitalization rate to 52% and reduced the outpatient failure rate to 3.9%, slightly better than A-DROP ≥ 2 (54% and 4.3%) and CURB-65 ≥ 2 (49% and 5.1%).
  
  
  CONCLUSIONS
  Our admission criteria agreed acceptably with overall observed admission decisions for patients presenting to EDs with pneumonia, but may safely reduce hospital admission rates and increase recognition of patients at risk for outpatient failure compared to CURB-65 ≥ 2 or A-DROP ≥ 2.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, University of Utah, 30N 1900E 701 Wintrobe, Salt Lake City, UT 84132, USA. Barbara.jones@hsc.utah.edu.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Jones
authors.forename: Jason P
authors.initials: JP
authors.lastname: Jones
authors.forename: Caroline G
authors.initials: CG
authors.lastname: Vines
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
mesh_terms: D019540:Area Under Curve; D003661:Decision Support Techniques; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000592:standards*; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D018579:Patient Selection; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality*; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D014589:Utah