Clinical Judgment versus the Pneumonia Severity Index in Making the Admission Decision

Seymann, Gregory; Barger, Khamisah; Choo, Susan; Sawhney, Sajeet; Davis, Daniel P.

doi:10.1016/j.jemermed.2007.05.050

Cited by 21 publications

(20 citation statements)

References 24 publications

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“…Despite the availability of these scores and the finding that outpatient management for selected patients is both safe and acceptable to patients, studies continue to show that the majority of low-risk patients presenting to hospital are admitted [4,[16][17][18][19][20][21][22][23].…”

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confidence: 99%

Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients

Choudhury

Chalmers²,

Mandal³

et al. 2011

Eur Respir J

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This study investigates the reasons for hospitalisation in patients with low-risk (CURB-65 score 0-1) community-acquired pneumonia (CAP), with a view to identifying the potential for improving outpatient management.As part of a prospective observational study of CAP, we evaluated reasons for hospitalisation in these low-risk patients.565 patients had low-risk CAP and 420 of these were admitted (for .12 h). 39.3% had additional markers of severity justifying admission, 29.5% of the admissions were required for further management that could not be provided rapidly in the community, 11.9% had unsafe social circumstances and 19.3% had no clinical reason justifying hospitalisation. 30-day mortality was increased in patients with additional severity markers (6.7%), which was significantly higher compared with 0% for patients awaiting investigations (p50.009) and 0% without a clear indication for hospitalisation (p50.04). In a logistic regression analysis, parameters associated with 30-day mortality were chronic cardiac comorbidity (adjusted odds ratio (aOR) 5.73, 95% CI 1.52-21.6; p50.01), acidosis (aOR 5.14, 95% CI 1.44-18.3; p50.01), hypoxia (aOR 9.86, 95% CI 2.39-40.7; p50.002) and multilobar chest radiograph shadowing (aOR 4.54, 95% CI 1.21-17.1; p50.03).This study supports recommendations from international guidelines that pneumonia severity scores should be used as an adjunct to clinical judgement, when deciding on hospitalisation.

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confidence: 99%

Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients

Choudhury

Chalmers²,

Mandal³

et al. 2011

Eur Respir J

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“…These results are similar to the results of the study of Marras et al from 2000 (21). In a recent observational study, Seymann et al reported that 90% of CAP patients were admitted with significant comorbidities, despite a low-risk PSI class (22). Among 118 PSI low-risk CAP patients, 48 patients were admitted and only 5% of those hospitalized with low-risk CAP had no identifiable reason or comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…This result suggests the need to consider underlying airway disease as a factor requiring hospitalization in addition to the PSI. In a study by Seymann et al, hypoxia was the most frequent reason for admission of low-risk CAP patients, accounting for 48% of the admissions (22). However, the authors didn't comment on whether hypoxia was related to underlying airway diseases such as asthma or chronic obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Incorporating a Pneumonia Severity Index into the Admission Protocol for Community-Acquired Pneumonia

Jo¹,

Kim²,

Jung³

et al. 2012

The Journal of Emergency Medicine

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“…The most commonly recommended severity of illness scores are the pneumonia severity index (PSI) score and the CURB-65 (6,(8)(9)(10)(11). However, despite these validated severity of illness scores, several cohort studies have reported 26-62% of low risk CAP patients (PSI ≤2 or CURB-65 ≤1) are admitted to the hospital (12)(13)(14)(15)(16)(17). High health care resource utilization and incremental costs are driven by these low risk CAP patients (16,(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Discordance of physician clinical judgment vs. pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: a prospective multicenter study

et al. 2017

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Background:The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP.Methods: An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient.The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. Results: One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P<0.005). Conclusions: Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons.Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients.

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Clinical Judgment versus the Pneumonia Severity Index in Making the Admission Decision

Cited by 21 publications

References 24 publications

Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients

Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients

The Effects of Incorporating a Pneumonia Severity Index into the Admission Protocol for Community-Acquired Pneumonia

Discordance of physician clinical judgment vs. pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: a prospective multicenter study

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