Measuring symptomatic and functional recovery in patients with community-acquired pneumonia

Abstract

OBJECTIVE:To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community-acquired pneumonia. DESIGN:A prospective, multicenter cohort study.SETTING: Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff-model health maintenance organization. PATIENTS:Five hundred seventy-six adults (aged Ն 18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying. MEASUREMENTS AND MAIN RESULTS:The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia. A summary symptom score was tabulated as the sum of the five individual severity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presentation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively.CONCLUSIONS: Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits.

Patients hospitalized for community-acquired pneumonia present reduced functional performance

“…Our results are in agreement with those of Metlay et al 6 , who evaluated the SF-36 in patients with CAP and found similar scores for all SF-36 domains except the vitality and emotional role functioning.…”

“…Previous studies have shown that moderate to severe fatigue and dyspnea were the most commonly reported symptoms when CAP was diagnosed. The symptoms remained for seven days and could persist for up to 90 days 6 . High levels of inflammatory markers were found in patients hospitalized with CAP and were related to functional impairment, which was evaluated using a scale of daily activities 7 .…”

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

“…14 The US Pneumonia Patient Outcomes Research Team (PORT) reported that 59% of patients had a pneumonia-related ambulatory care visit in the month following a diagnosis of CAP. 6 However, in that multicenter study, over 60% of patients were treated in the community for their index diagnosis of CAP and no data are reported regarding rates of healthcare reconsultation in the hospitalised cohort alone. An unexpected result arising from this study was that the single independent predictor of healthcare reconsultation was female gender, with women being over three times more likely to seek healthcare advice after discharge.…”

“…Sample size calculations were estimated based on a reconsultation rate of 49% reported by Metlay et al in patients with low-severity CAP. 6 For a precision of ±1% with a two-sided 95% confidence interval (CI) for a single proportion, a minimum of 96 patients was required for this study.…”

“…6 Therefore, rates of healthcare reconsultation can be used as a surrogate for gauging significant residual morbidity after an episode of CAP requiring hospital admission. Hospital readmission rates are easily measured and have been extensively reported.…”