Initial risk class and length of hospital stay in community-acquired pneumonia

Menéndez, Rosário; Ferrando, David Ballester; Valles, José Manuel González y Fernández; Martínez, Emilio Jiménez; Perpiñá, M.

doi:10.1183/09031936.01.00090001

Cited by 61 publications

(52 citation statements)

References 27 publications

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“…Due to the retrospective study design of this survey, it may be that the lack of careful recording into the charts has caused an overestimation of unnecessary days of hospitalisation. However, our finding is unique: In a prospective survey where the physicians responsible for discharge were aware of the study, Menendez et al [30] reported that the overall percentage of patients with inappropriate length of hospital stay was 68%. In another prospective study, Halm et al [9] showed that 65-86% of 686 patients with CAP stayed in hospital for at least a 1 day after having reached stability.…”

Section: Discussionmentioning

confidence: 61%

A survey on hospitalised communityacquired pneumonia in Italy

Migliorati¹,

Boccoli

Bracci

et al. 2016

Monaldi Arch Chest Dis

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Background and aim. Community Acquired Pneumonia (CAP) remains a major cause of disease and death. We evaluated the levels of care, the outcome and the characteristics of hospitalised patients with CAP in a primary hospital in Italy. We also investigated the value of both the Pneumonia Severity Index (PSI) and the modified Appropriateness Evaluation Protocol (AEP) for recognising both the outcome and the unnecessary admissions and stay of hospitalised patients with CAP. Methods. A retrospective review of all the charts of adult patients with CAP at Manerbio, Brescia, Italy between January 2001 and December 2002 was performed. Results. We evaluated 148 patients; their mean age (±SD) was 70 (±17) years; 34% were female. Most patients (87%) had at least a concomitant co-morbid disease. The overall survival rate at 30 days was 88%. All but one death occurred in the high-risk group of patients according to the PSI. On the contrary, the death rate of patients with inappropriate hospital admission according to the AEP was high. Patients with high PSI score had a significantly longer hospital length of stay than the low-risk group. However, a substantial part of the hospital stay did not show any justification into the charts. Conclusions. The PSI, but not the AEP, upon hospital admission, was useful for evaluating the outcome of patients with CAP. The PSI score and the modified AEP can be useful for assessing the appropriateness of hospitalisation for patients with CAP. There is the need for a practical and validated tool to support physicians in their decision making regarding the early and safe discharge of hospitalised patients with CAP.

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Section: Discussionmentioning

confidence: 61%

A survey on hospitalised communityacquired pneumonia in Italy

Migliorati¹,

Boccoli

Bracci

et al. 2016

Monaldi Arch Chest Dis

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“…The current study, like others [16][17][18][19][20], shows the suitability of the risk factors for death of the PSI-scoring system in the present authors9 local setting. Other authors have shown that pre-defined PSI scores have a good discriminant capacity but risk of death is overestimated [21].…”

Section: Discussionmentioning

confidence: 95%

A prediction rule to identify allocation of inpatient care in community-acquired pneumonia

España¹,

Capelastegui²,

Quintana³

et al. 2003

Eur Respir J

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The current authors developed a new prediction rule based on the five risk classes defined by the Pneumonia Severity Index to identify allocation of inpatient care in community-acquired pneumonia.The decision to hospitalise in low-risk classes (I-III) was unquestionable, if the presence of one or more of the following were evident: arterial oxygen tensionv8.0 kPa (60 mmHg), shock, decompensated coexisting illnesses, pleural effusion, inability to maintain oral intake, social problem, and lack of response to previous adequate empirical antibiotic therapy.The results at 18 months after implementation of this new prediction rule are reported in a series of 616 patients. The mortality rate was 0.5% in 221 patients treated as outpatients versus 8.9% in 395 patients treated as inpatients. Specific additional criteria for hospitalisation included in the prediction rule were present in 106 of the 178 low-risk patients treated as inpatients, whereas in the remaining 72, the decision to hospitalise was apparently unjustified by the prediction rule. These 72 patients showed a better outcome (significantly shorter hospitalisation, days on intravenous antibiotics, mortality, and complicated course) than high-risk patients and low-risk patients who met the additional specific criteria for deciding hospital admission.Therefore, admission in these low-risk patients might have been avoided by strict adherence to the new prediction rule. Another relevant finding was that the Pneumonia Severity Index alone did not identify all patients who needed to be admitted to the hospital. Eur Respir J 2003; 21: 695-701.

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“…Tras analizar los criterios de ingresos de los pacientes afectos de NAC en nuestra serie, sólo cinco de ellos se consideraron como innecesarios; la tasa de reingresos (2,7%) ha sido más baja que las descritas (3,4%) (12).…”

Section: Discussionunclassified

¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad?

Menéndez

Serrano

Gonzalez

et al. 2006

An. Med. Interna (Madrid)

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INTRODUCCIÓNLa neumonía adquirida en la comunidad (NAC) es una entidad con una elevada incidencia, se estima entre 5-10 casos/100.000 habitantes y año en el adulto (1), que se acompaña de una alta morbimortalidad. Las complicaciones y el riesgo de muerte, junto a problemas médicos, psicológicos y sociales, determinan la indicación de tratamiento domiciliario u hospitalario. Existe una gran variabilidad en los criterios de hospitalización de la NAC en relación a la población estudiada y la impresión subjetiva del clínico (1).Fine y cols. en 1997 (2) propusieron una estratificación de [0212-7199 (2006)

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Initial risk class and length of hospital stay in community-acquired pneumonia

Cited by 61 publications

References 27 publications

A survey on hospitalised communityacquired pneumonia in Italy

A survey on hospitalised communityacquired pneumonia in Italy

A prediction rule to identify allocation of inpatient care in community-acquired pneumonia

¿Son las unidades de corta estancia médica un lugar adecuado para tratar la neumonía adquirida en la comunidad?

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