The Hospital Admission Decision for Patients With Community-Acquired Pneumonia

Fine, Michael J.; Hough, Linda J.; Medsger, Anne R.; Li, Yi-Hwei; Ricci, Edmund M.; Singer, Daniel E.; Marrie, Thomas J.; Coley, Christopher M.; Walsh, Mary B.; Karpf, Michael; Lahive, Karen C.; Kapoor, Wishwa N.

doi:10.1001/archinte.1997.00440220040006

Cited by 209 publications

(47 citation statements)

References 34 publications

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“…The framework of severity assessment includes outpatient, hospitalized, and intensive care unit pneumonia, which corresponds to mild, moderate, and severe pneumonia (1 1). According to Fine et al clinicians decide to treat for community-acquiredpneumoniason an outpatient basis: 1 Clinical appearance-not too sick, 2 normal respiratory status, 3 able to obtain oral intake, 4 normal metal status, 5 reliable patient (12). Although our eight patients had fever, they had no severe underlying disease and, no respiratory failure, no shock, were not too sick.…”

Section: Methodsmentioning

confidence: 94%

Chest CT Findings and Clinical Features in Mild Legionella Pneumonia

et al. 2003

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Section: Methodsmentioning

confidence: 94%

Chest CT Findings and Clinical Features in Mild Legionella Pneumonia

et al. 2003

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“…Healthcare resource utilisation, such as concomitant medications, diagnostic and therapeutic procedures, hospitalisation and visits to medical staff, were recorded. The parameters to calculate the PSI [8] for analysis were also collected at baseline. The consumption of main healthcare resources were described in the two treatment arms.…”

Section: Methodsmentioning

confidence: 99%

“…Of these, up to 20% will be hospitalised [6], resulting in major financial impact [7]. Hospitalisation is the prime driver of CAP-associated costs, as shown by FINE and coworkers [8,9], who developed criteria to predict either mortality or increased morbidity, the Pneumonia Severity Index (PSI) [8]. Clearly, both patients and the healthcare system would benefit if patients could be appropriately treated out of hospital or discharged earlier [9].…”

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confidence: 99%

Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

Torres¹,

Muir²,

Corris³

et al. 2003

Eur Respir J

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Based on recent guidelines for the management of community-acquired pneumonia, this study was designed to evaluate the effectiveness of a new fluoroquinolone compared with standard antimicrobial regimens, in conditions relating as closely as possible to the real world setting.In this study, 564 patients were randomised to either oral moxifloxacin (400 mg o.d.) or to standard oral therapy (amoxicillin 1 g t.i.d. or clarithromycin 500 mg b.i.d. alone or in combination) for up to 14 days using a double-blind procedure. The choice between the three standard regimens was made by the clinician prior to randomisation. Clinical response, quality of life, symptoms, healthcare resources and safety were assessed.In the per-protocol population, clinical success was reported for 201 of 215 (93.5%) and 217 of 231 (93.9%) in the moxifloxacin and standard groups, respectively, at 7-10 days post-therapy. At 28-35 days follow-up, continued clinical cure was observed in 183 of 192 (95.3%) moxifloxacin and 207 of 221 (93.7%) standard groups. Drug-related adverse events were reported in 55 of 274 (20%) moxifloxacin and 86 of 279 (31%) standard patients with diarrhoea w5%.Oral moxifloxacin monotherapy was as effective as, and better tolerated than, optimal antibiotic strategy represented either by mono-or combination therapy (amoxicillin and/or clarithromycin) in community-acquired pneumonia management.

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“…Algorithms to help clinicians decide upon hospital admission and discharge have been devised, validated and published [2][3][4][5][6]. These guidelines are robust and may decrease mortality [7,8].…”

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confidence: 99%

Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume

Marrie

Carrière²,

Jin³

et al. 2003

Eur Respir J

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The association of mortality with patient factors (severity of illness, comorbidity), physician factors (specialty training, prehospitalisation visit, in-hospital consultation, volume of patients seen per physician) and healthcare organisation factors (patient-travel distances, regional beds per capita, admitting hospital-bed occupancy, admitting hospital-bed turnover, hospital location, volume of pneumonia cases per hospital) after hospital admission with community-acquired pneumonia was investigated using administrative data from Alberta, Canada from April 1, 1994-March 31, 1999.During the 5-yr study period there were 43,642 pneumonia hospitalisations, with an 11% in-hospital and 26% 1-yr mortality. Patient severity of illness and comorbidity were the strongest predictors of increased mortality. Physicians with the highest inhospital pneumonia patient volume (w27 patients?yr -1 ) cared for patients with greater severity/comorbidity, but with decreased odds of in-hospital mortality, compared with the lowest volume physicians (less than seven patients per year).The effects of internal medicine specialist or subspecialist care were mixed, with a reduction in deaths for the first 72 h and an increase in in-hospital deaths. Prehospitalisation visit by a physician was associated with decreased mortality. Healthcare organisation factors were the least strong predictor of mortality, demonstrating an effect only for 1-yr mortality in those discharged alive from hospital. Admissions to larger volume or metropolitan hospitals were associated with a decrease in mortality.Severity of illness and comorbidity had the strongest association with mortality. The first association of high-volume physician and pre-hospital care with decreased inhospital mortality for community-acquired pneumonia is reported. Eur Respir J 2003; 22: 148-155.

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The Hospital Admission Decision for Patients With Community-Acquired Pneumonia

Cited by 209 publications

References 34 publications

Chest CT Findings and Clinical Features in Mild Legionella Pneumonia

Chest CT Findings and Clinical Features in Mild Legionella Pneumonia

Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume

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