Identification of Low-Risk Hospitalized Patients With Pneumonia: Results
A total of 503 consecutively hospitalized patients between June 1, 1990, and May 30, 1991, with pneumonia were enrolled. Medical records were available for abstraction on 97 percent of patients. The average age of study patients was 72.2 ±18.1 years old (mean±SD); 74 percent of patients were 65 years of age or older. Fifty-eight percent of patients were women. The mean length of hospital stay was 9.5 ±9.8 days and the mean ICU length of stay was 0.9 ± 3.9 days. Canadian neighbor pharmacy in detail The infectious etiologies of pneumonia for the study patients are as follows: Haemophilus influenzae, 34 (6.7 percent); Streptococcus pneumoniae, 25 (5.0 percent); Pseudomonas aeruginosa, 25 (5.0 percent); S aureus, 21 (4.2 percent); other Gram-negative bacillary pneumonia, 22 (4.4 percent); Klebsiella pneumoniae, 14 (2.8 percent); Mycoplasma pneumoniae, 12 (2.4 percent); Legionella pneumophila, 1 (0.2 percent); Moraxella catarrhalis, 5 (1.0 percent); unknown, 324 (64.4 percent); other, 20 (4.0 percent).
Many patients had at least one underlying comorbid disease. Sixty-four percent of patients had serious underlying comorbid diseases, 35 percent of patients had preexisting lung disease, and 19 percent of patients had an underlying malignancy. A total of 31 percent of patients received oral antimicrobial therapy prior to hospital admission. Patients had symptoms of fever in 76 percent of cases, dyspnea in 61 percent of cases, and pleuritic chest pain in 25 percent of cases. The chest radiograph demonstrated multilobar involvement for 36 percent of patients, a pleural effusion in 16 percent of patients, and congestive heart failure in 11 percent of patients.
The discharge disposition of the patients was as follows: 71 percent of patients were discharged to their homes, 14 percent of patients were discharged to a nursing home, 12 percent of patients died, 3 percent of patients were transferred to another hospital, and 1 percent of patients were transferred to a rehabilitation or a chemical dependency center.
Thirty-three percent of pneumonia patients were classified as low-risk 3 days after hospital admission according to the guideline (n=166); 39 percent of the population of pneumonia patients were hospitalized more than 3 days. The reasons why patients were judged to be ineligible for classification by the guideline or judged to be at high risk by the guideline included (1) length of hospital stay of 3 days or fewer due to hospital discharge or early death (n=73), (2) life-threatening complication within the first 3 hospital days (n=115), (3) obvious clinical reason for continued hospitalization explicitly defined before the study (n=252), or (4) infection by a high-risk pneumonia pathogen explicitly defined prior to the study (n=129). Many patients had more than one reason that caused them to be ineligible for classification by the guideline or at high risk according to the guideline.
Category: Respiratory Symptoms
Tags: antimicrobial therapy, congestive heart failure, healthcare costs, hospitalization, pneumonia