title: Intensive Care Unit Admission With Community-Acquired Pneumonia.
abstract: BACKGROUND
  There has been a dramatic increase in the use of intensive care units (ICUs) over the past 25 years. Greater use of validated measures of illness severity may better inform ICU admission decisions in patients with community-acquired pneumonia. This article examined predictors of ICU admission and hospitalization costs, including the pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, blood pressure, age ≥65 years) scores.
  
  
  METHODS
  The study identified 422 patients hospitalized for community-acquired pneumonia, ascertaining patient characteristics by chart review and extraction of administrative data. Multivariate logistic regression was performed to quantify the association of the PSI, CURB-65 and comorbidities with ICU admission. The predictors of cost were estimated using a generalized linear model.
  
  
  RESULTS
  Compared to 194 general medicine patients, certain clinical and radiographic findings were more common among 228 ICU patients. Compared to PSI reference group I/II/III, ICU admission was strongly associated with risk class IV (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63-5.72) and V (OR, 4.84; CI, 2.44-9.62), and also CURB-65 ≥3 (OR, 2.90; CI, 1.51-5.56). The relative increase in mortality among PSI risk class V (compared to IV) patients was 2.68 times higher in general medicine, compared with the ICU. Among ICU admissions, risk class V was associated with an additional cost of $14,548 (95% CI, $4,232 to $24,864).
  
  
  CONCLUSIONS
  Illness severity and chronic pulmonary disease are strong predictors of ICU admission. More extensive use of the PSI may optimize site-of-care decisions, thereby minimizing mortality and unnecessary resource utilization.
authors.affiliation: Department of Medicine (ASV), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, Department of Medicine (DOM, GWR), Section of Hospital Medicine, University of Chicago, Chicago, Illinois, Department of Health Management and Policy (HJT), University of North Texas Health Science Center, Fort Worth, Texas; and University of Pittsburgh School of Medicine (MBS), Pittsburgh, Pennsylvania.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Vohra
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Tak
authors.forename: Maulin B
authors.initials: MB
authors.lastname: Shah
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Ruhnke
mesh_terms: D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology