Source: Annual Congress 2001 - Community-acquired pneumonia: from diagnosis to discharge
Disease area: Respiratory infections

Abstract

Background: A prediction rule and critical pathway now exist in the literature to allow identification of patients with community acquired pneumonia (CAP) who require hospital admission (Fine et al N Engl Jour Med 1997; 336:243. Marrie et al JAMA 2000; 283:749). This allows identification of patients at high risk however it is unclear as to the outcome of patients sent home under this scoring system.
Methods: All patients seen in Emergency and sent home with a diagnosis of CAP from Jan 1/99 to Jan 31/00 were followed. Demographic data was collected for this group as well as data on the antibiotic given at discharge. They were then followed by phone contact 24-72 hours following discharge by a nurse to report their status.
Results: A total of 123 outpatients were followed with an average age of 58.2 (range 16 - 92) years and an average Pneumonia Severity Index (PSI) of 60.6 (range 8-112). The antibiotic prescribed for these patients was a macrolide in 66%, a second generation cephalosporin in 16% and a respiratory fluoroquinolone in 15%. Follow-up status of these patients at 24 to 72 hours showed that 76% stated they were improved, 17% stated they were the same, 4% said they were worse and 2 patients were admitted to hospital. The patients reporting feeling worse were from PSI risk classes 2 (14%), 3 (43%) and 4 (43%).
Conclusion: The Pneumonia Critical Pathway appears to perform well in picking thise patients who will do well with treatment in an outpatient setting. A large number of the patients who did poorly were PSI class 4 which would indicate a worse outcome and require hospital admission.

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W. D. Patrick, P. Hernandez, S. Campbell, B. Carr, A. McIvor, S. Varley-Doyle, M. Els, G. A. Patrick, C. Touchie, T. J. Marrie (Halifax, Ottawa, Edmonton, Canada). Evaluation of the outpatients' performance of a pneumonia critical pathway in a teaching hospital. Eur Respir J 2001; 16: Suppl. 31, 3396

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