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Published in: Current Infectious Disease Reports 2/2013

01-04-2013 | RESPIRATORY INFECTIONS (F ARNOLD, SECTION EDITOR)

Hospital Admission Decision for Patients with Community-Acquired Pneumonia

Authors: Stefano Aliberti, Paola Faverio, Francesco Blasi

Published in: Current Infectious Disease Reports | Issue 2/2013

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Abstract

Where to treat patients is probably the single most important decision in the management of community-acquired pneumonia (CAP), with a substantial impact on both patients’ outcomes and health-care costs. Several factors can contribute to the decision of the site of care for CAP patients, including physicians’ experience and clinical judgment and severity scores developed to predict mortality, as well as social and health-care-related issues. The recognition, both in the community and in the emergency department, of the presence of severe sepsis and acute respiratory failure and the coexistence with unstable comorbidities other than CAP are indications for hospital admission. In all the other cases, physician’s choice to admit CAP patients should be validated against at least one objective tool of risk assessment, with a clear understanding of each score’s limitations.
Literature
1.
go back to reference Raut M, Schein J, Mody S, et al. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin. 2009;25:2151–7.PubMedCrossRef Raut M, Schein J, Mody S, et al. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin. 2009;25:2151–7.PubMedCrossRef
2.
go back to reference Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.PubMedCrossRef Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.PubMedCrossRef
3.
go back to reference Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections–full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1–59.PubMedCrossRef Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections–full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1–59.PubMedCrossRef
4.
go back to reference Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64 Suppl 3:iii1–55.PubMedCrossRef Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64 Suppl 3:iii1–55.PubMedCrossRef
5.
go back to reference Chalmers JD, Taylor J, Mandal P, et al. Validation of the IDSA/ATS minor criteria for ICU admission in communityacquired pneumonia patients without major criteria or contraindications to ICU care. Clin Infect Dis. 2011;53:107–13.PubMedCrossRef Chalmers JD, Taylor J, Mandal P, et al. Validation of the IDSA/ATS minor criteria for ICU admission in communityacquired pneumonia patients without major criteria or contraindications to ICU care. Clin Infect Dis. 2011;53:107–13.PubMedCrossRef
6.
go back to reference Phua J, See KC, Chan YH, et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe communityacquired pneumonia. Thorax. 2009;64:598–603.PubMedCrossRef Phua J, See KC, Chan YH, et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe communityacquired pneumonia. Thorax. 2009;64:598–603.PubMedCrossRef
7.
go back to reference Rello J, Rodriguez A, Lisboa T, et al. PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med. 2009;37:456–62.PubMedCrossRef Rello J, Rodriguez A, Lisboa T, et al. PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med. 2009;37:456–62.PubMedCrossRef
8.
go back to reference Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–84.PubMedCrossRef Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–84.PubMedCrossRef
9.
go back to reference Kohno S, Seki M, Watanabe A. Evaluation of an assessment system for the JRS 2005: A-DROP for the management of CAP in adults. Intern Med. 2011;50:1183–91.PubMedCrossRef Kohno S, Seki M, Watanabe A. Evaluation of an assessment system for the JRS 2005: A-DROP for the management of CAP in adults. Intern Med. 2011;50:1183–91.PubMedCrossRef
10.
go back to reference Buising KL, Thursky KA, Black JF, et al. Identifying severe community-acquired pneumonia in the emergency department: a simple clinical prediction tool. Emerg Med Australas. 2007;19:418–26.PubMedCrossRef Buising KL, Thursky KA, Black JF, et al. Identifying severe community-acquired pneumonia in the emergency department: a simple clinical prediction tool. Emerg Med Australas. 2007;19:418–26.PubMedCrossRef
11.
go back to reference Renaud B, Labarere J, Coma E, et al. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule. Crit Care. 2009;13:R54.PubMedCrossRef Renaud B, Labarere J, Coma E, et al. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule. Crit Care. 2009;13:R54.PubMedCrossRef
12.
go back to reference Espana PP, Capelastegui A, Gorordo I, et al. Development and validation of a clinical prediction rule for severe communityacquired pneumonia. Am J Respir Crit Care Med. 2006;174:1249–56.PubMedCrossRef Espana PP, Capelastegui A, Gorordo I, et al. Development and validation of a clinical prediction rule for severe communityacquired pneumonia. Am J Respir Crit Care Med. 2006;174:1249–56.PubMedCrossRef
13.
go back to reference Yandiola PP, Capelastegui A, Quintana J, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest. 2009;135:1572–9.PubMedCrossRef Yandiola PP, Capelastegui A, Quintana J, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest. 2009;135:1572–9.PubMedCrossRef
14.
go back to reference Chalmers JD, Mandal P, Singanayagam A, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med. 2011;37:1409–20.PubMedCrossRef Chalmers JD, Mandal P, Singanayagam A, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med. 2011;37:1409–20.PubMedCrossRef
15.
go back to reference Jin Y, Marrie TJ, Carriere KC, et al. Variation in management of community-acquired pneumonia requiring admission to Alberta. Canada hospitals. Epidemiol Infect. 2003;130:41–5.PubMedCrossRef Jin Y, Marrie TJ, Carriere KC, et al. Variation in management of community-acquired pneumonia requiring admission to Alberta. Canada hospitals. Epidemiol Infect. 2003;130:41–5.PubMedCrossRef
16.
go back to reference Dean NC, Jones JP, Aronsky D, et al. Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department. Ann Emerg Med. 2012;59:35–41.PubMedCrossRef Dean NC, Jones JP, Aronsky D, et al. Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department. Ann Emerg Med. 2012;59:35–41.PubMedCrossRef
17.
go back to reference Fine MJ, Hough LJ, Medsger AR, et al. The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 1997;157:36–44.PubMedCrossRef Fine MJ, Hough LJ, Medsger AR, et al. The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 1997;157:36–44.PubMedCrossRef
18.
go back to reference Barlow G, Nathwani D, Myers E, et al. Identifying barriers to the rapid administration appropriate antibiotics in communityacquired pneumonia. J Antimicrob Chemother. 2008;61:442–51.PubMedCrossRef Barlow G, Nathwani D, Myers E, et al. Identifying barriers to the rapid administration appropriate antibiotics in communityacquired pneumonia. J Antimicrob Chemother. 2008;61:442–51.PubMedCrossRef
19.
go back to reference Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.PubMedCrossRef Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.PubMedCrossRef
20.
go back to reference Woodhead M. Assessment of illness severity in community acquired pneumonia: a useful new prediction tool? Thorax. 2003;58:371–2.PubMedCrossRef Woodhead M. Assessment of illness severity in community acquired pneumonia: a useful new prediction tool? Thorax. 2003;58:371–2.PubMedCrossRef
21.
go back to reference Arnold F, LaJoie A, Marrie T, et al. The pneumonia severity index predicts time to clinical stability in patients with community-acquired pneumonia. Int J Tuberc Lung Dis. 2006;10:739–43.PubMed Arnold F, LaJoie A, Marrie T, et al. The pneumonia severity index predicts time to clinical stability in patients with community-acquired pneumonia. Int J Tuberc Lung Dis. 2006;10:739–43.PubMed
22.
go back to reference Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.PubMedCrossRef Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82.PubMedCrossRef
23.
go back to reference Capelastegui A, España PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27:151–7.PubMedCrossRef Capelastegui A, España PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27:151–7.PubMedCrossRef
24.
go back to reference Bauer TT, Ewig S, Marre R, et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260:93–101.PubMedCrossRef Bauer TT, Ewig S, Marre R, et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260:93–101.PubMedCrossRef
25.
go back to reference •• Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010;65(10):878–83. This is a recent systematic review and meta-analysis of 40 studies focused on prognostic information of PSI, CURB-65, and CRB-65 and showing no significant differences in overall test performance among the three scores for predicting mortality from community-acquired pneumonia.PubMedCrossRef •• Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax. 2010;65(10):878–83. This is a recent systematic review and meta-analysis of 40 studies focused on prognostic information of PSI, CURB-65, and CRB-65 and showing no significant differences in overall test performance among the three scores for predicting mortality from community-acquired pneumonia.PubMedCrossRef
26.
go back to reference Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax. 2010;65:884–90.PubMedCrossRef Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax. 2010;65:884–90.PubMedCrossRef
27.
go back to reference Arnold FW, Wiemken T, Peyrani P, et al. Outcomes in females hospitalised with community-acquired pneumonia are worse than males. Eur Respir J. 2012 Jul 26. [Epub ahead of print] Arnold FW, Wiemken T, Peyrani P, et al. Outcomes in females hospitalised with community-acquired pneumonia are worse than males. Eur Respir J. 2012 Jul 26. [Epub ahead of print]
28.
go back to reference Parsonage M, Nathwani D, Davey P, Barlow G. Evaluation of the performance of CURB-65 with increasing age. Clin Microbiol Infect. 2009;15:858–64.PubMedCrossRef Parsonage M, Nathwani D, Davey P, Barlow G. Evaluation of the performance of CURB-65 with increasing age. Clin Microbiol Infect. 2009;15:858–64.PubMedCrossRef
29.
go back to reference Myint PK, Kamath AV, Vowler SL, et al. The CURB (confusion, urea, respiratory rate and blood pressure) criteria in community-acquired pneumonia (CAP) in hospitalised elderly patients aged 65 years and over: a prospective observational cohort study. Age Ageing. 2005;34:75–7.PubMedCrossRef Myint PK, Kamath AV, Vowler SL, et al. The CURB (confusion, urea, respiratory rate and blood pressure) criteria in community-acquired pneumonia (CAP) in hospitalised elderly patients aged 65 years and over: a prospective observational cohort study. Age Ageing. 2005;34:75–7.PubMedCrossRef
30.
go back to reference Chen JH, Chang SS, Liu JJ, et al. Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects. Thorax. 2010;65:971–7.PubMedCrossRef Chen JH, Chang SS, Liu JJ, et al. Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects. Thorax. 2010;65:971–7.PubMedCrossRef
31.
go back to reference Heppner HJ, Sehlhoff B, Niklaus D, et al. Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia. Z Gerontol Geriatr. 2011;44:229–34.PubMedCrossRef Heppner HJ, Sehlhoff B, Niklaus D, et al. Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia. Z Gerontol Geriatr. 2011;44:229–34.PubMedCrossRef
32.
go back to reference Fang WF, Yang KY, Wu CL, et al. Application and comparison of severity indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. 2011;15:R32.PubMedCrossRef Fang WF, Yang KY, Wu CL, et al. Application and comparison of severity indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. 2011;15:R32.PubMedCrossRef
33.
go back to reference Falcone M, Corrao S, Venditti M, et al. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia. Intern Emerg Med. 2011;6:431–6.PubMedCrossRef Falcone M, Corrao S, Venditti M, et al. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia. Intern Emerg Med. 2011;6:431–6.PubMedCrossRef
34.
go back to reference Mulrennan S, Tempone SS, Ling IT, et al. Pandemic influenza (H1N1) 2009 pneumonia: CURB-65 score for predicting severity and nasopharyngeal sampling for diagnosis are unreliable. PLoS One. 2010;5:e12849.PubMedCrossRef Mulrennan S, Tempone SS, Ling IT, et al. Pandemic influenza (H1N1) 2009 pneumonia: CURB-65 score for predicting severity and nasopharyngeal sampling for diagnosis are unreliable. PLoS One. 2010;5:e12849.PubMedCrossRef
35.
go back to reference Bjarnason A, Thorleifsdottir G, Löve A, et al. Severity of Influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. PLoS One. 2012;7:e46816.PubMedCrossRef Bjarnason A, Thorleifsdottir G, Löve A, et al. Severity of Influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study. PLoS One. 2012;7:e46816.PubMedCrossRef
36.
go back to reference Myles PR, Nguyen-Van-Tam JS, Lim WS, et al. Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data. PLoS One. 2012;7:e34428.PubMedCrossRef Myles PR, Nguyen-Van-Tam JS, Lim WS, et al. Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data. PLoS One. 2012;7:e34428.PubMedCrossRef
37.
go back to reference Commons RJ, Denholm J. Triaging pandemic flu: pneumonia severity scores are not the answer. Int J Tuberc Lung Dis. 2012;16:670–3.PubMed Commons RJ, Denholm J. Triaging pandemic flu: pneumonia severity scores are not the answer. Int J Tuberc Lung Dis. 2012;16:670–3.PubMed
38.
go back to reference Pereira JM, Moreno RP, Matos R, et al. Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia. Clin Microbiol Infect. 2012;18:1040–8.PubMedCrossRef Pereira JM, Moreno RP, Matos R, et al. Severity assessment tools in ICU patients with 2009 Influenza A (H1N1) pneumonia. Clin Microbiol Infect. 2012;18:1040–8.PubMedCrossRef
39.
go back to reference Aliberti S, Brock GN, Peyrani P, et al. The pneumonia severity index and the CRB-65 in cancer patients with community-acquired pneumonia. Int J Tuberc Lung Dis. 2009;13:1550–6.PubMed Aliberti S, Brock GN, Peyrani P, et al. The pneumonia severity index and the CRB-65 in cancer patients with community-acquired pneumonia. Int J Tuberc Lung Dis. 2009;13:1550–6.PubMed
40.
go back to reference Asai N, Motojima S, Ohkuni Y, et al. Non-HIV Pneumocystis pneumonia: do conventional community-acquired pneumonia guidelines under estimate its severity? Multidiscip Respir Med. 2012;11(7):2.CrossRef Asai N, Motojima S, Ohkuni Y, et al. Non-HIV Pneumocystis pneumonia: do conventional community-acquired pneumonia guidelines under estimate its severity? Multidiscip Respir Med. 2012;11(7):2.CrossRef
41.
go back to reference Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother. 2008;61:976–94.PubMedCrossRef Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother. 2008;61:976–94.PubMedCrossRef
42.
go back to reference Menéndez R, Martínez R, Reyes S, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009;64:587–91.PubMedCrossRef Menéndez R, Martínez R, Reyes S, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 2009;64:587–91.PubMedCrossRef
43.
go back to reference Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008;31:349–55.PubMedCrossRef Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008;31:349–55.PubMedCrossRef
44.
go back to reference Huang DT, Weissfeld LA, Kellum JA, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008;52:48–58.PubMedCrossRef Huang DT, Weissfeld LA, Kellum JA, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008;52:48–58.PubMedCrossRef
45.
go back to reference Huang DT, Angus DC, Kellum JA, et al. Midregional proadrenomedullin as a prognostic tool in community acquired pneumonia. Chest. 2009;136:823–31.PubMedCrossRef Huang DT, Angus DC, Kellum JA, et al. Midregional proadrenomedullin as a prognostic tool in community acquired pneumonia. Chest. 2009;136:823–31.PubMedCrossRef
46.
go back to reference • Krüger S, Ewig S, Giersdorf S, et al. Cardiovascular and inflammatory biomarkers to predict short- and longterm survival in community-acquired pneumonia: results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med. 2010;182:1426–34. In this study, performed on more than 700 patients with CAP, the authors showed proadrenomedullin, proatrial natriuretic peptide, and copeptin to be good predictors of short- and long-term all-cause mortality, superior to inflammatory markers and at least comparable to CRB-65 score.PubMedCrossRef • Krüger S, Ewig S, Giersdorf S, et al. Cardiovascular and inflammatory biomarkers to predict short- and longterm survival in community-acquired pneumonia: results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med. 2010;182:1426–34. In this study, performed on more than 700 patients with CAP, the authors showed proadrenomedullin, proatrial natriuretic peptide, and copeptin to be good predictors of short- and long-term all-cause mortality, superior to inflammatory markers and at least comparable to CRB-65 score.PubMedCrossRef
47.
go back to reference Courtais C, Kuster N, Dupuy AM, et al. Proadrenomedullin, a useful tool for risk stratification in high Pneumonia Severity Index score community acquired pneumonia. Am J Emerg Med. 2012. doi:10.1016/j.ajem.2012.07.017. Courtais C, Kuster N, Dupuy AM, et al. Proadrenomedullin, a useful tool for risk stratification in high Pneumonia Severity Index score community acquired pneumonia. Am J Emerg Med. 2012. doi:10.​1016/​j.​ajem.​2012.​07.​017.
48.
go back to reference Albrich WC, Dusemund F, Rüegger K, et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis. 2011;3(11):112.CrossRef Albrich WC, Dusemund F, Rüegger K, et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis. 2011;3(11):112.CrossRef
49.
go back to reference Krüger S, Papassotiriou J, Marre R, et al. Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med. 2007;33:2069–78.PubMedCrossRef Krüger S, Papassotiriou J, Marre R, et al. Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med. 2007;33:2069–78.PubMedCrossRef
50.
go back to reference Kolditz M, Höffken G, Martus P, et al. Serum cortisol predicts death and critical disease independently of CRB-65 score in community-acquired pneumonia: a prospective observational cohort study. BMC Infect Dis. 2012;13(12):90.CrossRef Kolditz M, Höffken G, Martus P, et al. Serum cortisol predicts death and critical disease independently of CRB-65 score in community-acquired pneumonia: a prospective observational cohort study. BMC Infect Dis. 2012;13(12):90.CrossRef
51.
go back to reference Christ-Crain M, Stolz D, Jutla S, et al. Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;176:913–20.PubMedCrossRef Christ-Crain M, Stolz D, Jutla S, et al. Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med. 2007;176:913–20.PubMedCrossRef
52.
go back to reference Marrie TJ, Lau CY, Wheeler SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia.CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000;283:749–55.PubMedCrossRef Marrie TJ, Lau CY, Wheeler SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia.CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000;283:749–55.PubMedCrossRef
53.
go back to reference Carratala J, Fernandez-Sabe N, Ortega L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142:165–72.PubMed Carratala J, Fernandez-Sabe N, Ortega L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142:165–72.PubMed
54.
go back to reference Yealy DM, Auble TE, Stone RA, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized controlled trial. Ann Intern Med. 2005;143:881–94.PubMed Yealy DM, Auble TE, Stone RA, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized controlled trial. Ann Intern Med. 2005;143:881–94.PubMed
55.
go back to reference Atlas SJ, Benzer TI, Borowsky LH, et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern Med. 1998;158:1350–6.PubMedCrossRef Atlas SJ, Benzer TI, Borowsky LH, et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern Med. 1998;158:1350–6.PubMedCrossRef
56.
go back to reference Renaud B, Coma E, Labarere J, et al. Routine use of the pneumonia severity index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis. 2007;44:41–9.PubMedCrossRef Renaud B, Coma E, Labarere J, et al. Routine use of the pneumonia severity index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis. 2007;44:41–9.PubMedCrossRef
57.
go back to reference Jo S, Kim K, Jung K, et al. The effects of incorporating a pneumonia severity index into the admission protocol for community-acquired pneumonia. J Emerg Med 2010 [epub ahead of print]. Jo S, Kim K, Jung K, et al. The effects of incorporating a pneumonia severity index into the admission protocol for community-acquired pneumonia. J Emerg Med 2010 [epub ahead of print].
58.
go back to reference Chalmers JD, Akram AR, Hill AT. Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis. Eur Respir J. 2011;37:858–64.PubMedCrossRef Chalmers JD, Akram AR, Hill AT. Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis. Eur Respir J. 2011;37:858–64.PubMedCrossRef
59.
go back to reference Seymann G, Barger K, Choo S, et al. Clinical judgment versus the Pneumonia Severity Index in making the admission decision. J Emerg Med. 2008;34:261–8.PubMedCrossRef Seymann G, Barger K, Choo S, et al. Clinical judgment versus the Pneumonia Severity Index in making the admission decision. J Emerg Med. 2008;34:261–8.PubMedCrossRef
60.
go back to reference Marrie TJ, Huang JQ. Low-risk patients admitted with community-acquired pneumonia. Am J Med. 2005;118:1357–63.PubMedCrossRef Marrie TJ, Huang JQ. Low-risk patients admitted with community-acquired pneumonia. Am J Med. 2005;118:1357–63.PubMedCrossRef
61.
go back to reference Arnold FW, Ramirez JA, McDonald LC, Xia EL. Hospitalization for communityacquired pneumonia: the pneumonia severity index vs clinical judgement. Chest. 2003;124:121–4.PubMedCrossRef Arnold FW, Ramirez JA, McDonald LC, Xia EL. Hospitalization for communityacquired pneumonia: the pneumonia severity index vs clinical judgement. Chest. 2003;124:121–4.PubMedCrossRef
62.
go back to reference Chan SS. The Pneumonia Severity Index as a decision-making tool to guide patient disposition. Am J Emerg Med. 2002;20:387–8.PubMedCrossRef Chan SS. The Pneumonia Severity Index as a decision-making tool to guide patient disposition. Am J Emerg Med. 2002;20:387–8.PubMedCrossRef
63.
go back to reference Ewig S, de Roux A, Garcia E, et al. Validation of predictive rules and indices of severity for community-acquired pneumonia. Thorax. 2004;59:421–7.PubMedCrossRef Ewig S, de Roux A, Garcia E, et al. Validation of predictive rules and indices of severity for community-acquired pneumonia. Thorax. 2004;59:421–7.PubMedCrossRef
64.
go back to reference Goss CH, Rubenfeld GD, Park DR, et al. Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124:2148–55.PubMedCrossRef Goss CH, Rubenfeld GD, Park DR, et al. Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124:2148–55.PubMedCrossRef
65.
go back to reference Marras TK, Gutierrez C, Chan CK. Applying a prediction rule to iden tify low-risk patients with community-acquired pneumonia. Chest. 2000;118:1339–43.PubMedCrossRef Marras TK, Gutierrez C, Chan CK. Applying a prediction rule to iden tify low-risk patients with community-acquired pneumonia. Chest. 2000;118:1339–43.PubMedCrossRef
66.
go back to reference Espana PP, Capelastegui A, Quintana JM, et al. A prediction rule to identify allocation of inpatient care in community-acquired pneumonia. Eur Respir J. 2003;21:695–701.PubMedCrossRef Espana PP, Capelastegui A, Quintana JM, et al. A prediction rule to identify allocation of inpatient care in community-acquired pneumonia. Eur Respir J. 2003;21:695–701.PubMedCrossRef
67.
go back to reference • Aujesky D, McCausland JB, Whittle J, et al. Reasons why emergency department providers do not rely on the pneumonia severity index to determine the initial site of treatment for patients with pneumonia. Clin Infect Dis. 2009;49(10):e100–8. This trial enrolling more than 1,300 patients showed that emergency medicine physicians tend to hospitalize many low-risk patients with CAP, most frequently for a comorbid illness.PubMedCrossRef • Aujesky D, McCausland JB, Whittle J, et al. Reasons why emergency department providers do not rely on the pneumonia severity index to determine the initial site of treatment for patients with pneumonia. Clin Infect Dis. 2009;49(10):e100–8. This trial enrolling more than 1,300 patients showed that emergency medicine physicians tend to hospitalize many low-risk patients with CAP, most frequently for a comorbid illness.PubMedCrossRef
68.
go back to reference Marrie TJ, Huang JQ. Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in the emergency room. Can Respir J. 2007;14:212–6.PubMed Marrie TJ, Huang JQ. Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in the emergency room. Can Respir J. 2007;14:212–6.PubMed
69.
go back to reference Singanayagam A, Wood V, Chalmers JD. Factors associated with severe illness in Pandemic 2009 influenza A (H1N1) infection: implications for triage in primary and secondary care. J Infect. 2011;63:243–51.PubMedCrossRef Singanayagam A, Wood V, Chalmers JD. Factors associated with severe illness in Pandemic 2009 influenza A (H1N1) infection: implications for triage in primary and secondary care. J Infect. 2011;63:243–51.PubMedCrossRef
70.
go back to reference Riquelme R, Jimenez P, Videla AJ, et al. Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia. Int J Tuberc Lung Dis. 2011;15:542–6.PubMedCrossRef Riquelme R, Jimenez P, Videla AJ, et al. Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia. Int J Tuberc Lung Dis. 2011;15:542–6.PubMedCrossRef
71.
go back to reference McCartney C, Cookson B, Dance D. Interim guidance on diagnosis and management of Panton–Valentine leukocidin-associated staphylococcal infections in the UK. London: Department of Health; 2006. McCartney C, Cookson B, Dance D. Interim guidance on diagnosis and management of Panton–Valentine leukocidin-associated staphylococcal infections in the UK. London: Department of Health; 2006.
72.
go back to reference Aliberti S, Ramirez J, Cosentini R, et al. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. 2011;105:1732–8.PubMedCrossRef Aliberti S, Ramirez J, Cosentini R, et al. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. 2011;105:1732–8.PubMedCrossRef
73.
go back to reference Choudhury G, Chalmers JD, Mandal P, et al. Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients. Eur Respir J. 2011;38:643–8.PubMedCrossRef Choudhury G, Chalmers JD, Mandal P, et al. Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients. Eur Respir J. 2011;38:643–8.PubMedCrossRef
74.
go back to reference Sanz F, Restrepo MI, Fernández E, et al. Hypoxemia adds to the CURB-65 pneumonia severity score in hospitalized patients with mild pneumonia. Respir Care. 2011;56:612–8.PubMedCrossRef Sanz F, Restrepo MI, Fernández E, et al. Hypoxemia adds to the CURB-65 pneumonia severity score in hospitalized patients with mild pneumonia. Respir Care. 2011;56:612–8.PubMedCrossRef
75.
go back to reference •• Kolditz M, Ewig S, Höffken G. Management-based risk prediction in community-acquired pneumonia by scores and biomarkers. Eur Respir J 2012, Sep 27. [Epub ahead of print]. This paper gives a very interesting perspective on site-of-care decision in patients with community-acquired pneumonia. An integration between a physiopathological approach and severity scores is discussed, and a possible role of biomarkers is proposed. •• Kolditz M, Ewig S, Höffken G. Management-based risk prediction in community-acquired pneumonia by scores and biomarkers. Eur Respir J 2012, Sep 27. [Epub ahead of print]. This paper gives a very interesting perspective on site-of-care decision in patients with community-acquired pneumonia. An integration between a physiopathological approach and severity scores is discussed, and a possible role of biomarkers is proposed.
76.
go back to reference Lee RW, Lindstrom ST. A teaching hospital's experience applying the Pneumonia Severity index and antibiotic guidelines in the management of communityacquired pneumonia. Respirology. 2007;12:754–8.PubMedCrossRef Lee RW, Lindstrom ST. A teaching hospital's experience applying the Pneumonia Severity index and antibiotic guidelines in the management of communityacquired pneumonia. Respirology. 2007;12:754–8.PubMedCrossRef
77.
go back to reference Nadarajan P, Wilson L, Mohammed B, et al. Compliance in the measurement of CURB-65 in patients with community-acquired pneumonia and potential implications for early discharge. Ir Med J. 2008;101:144–6.PubMed Nadarajan P, Wilson L, Mohammed B, et al. Compliance in the measurement of CURB-65 in patients with community-acquired pneumonia and potential implications for early discharge. Ir Med J. 2008;101:144–6.PubMed
78.
go back to reference Karmakar G, Wilsher M. Use of the 'CURB 65' score in hospital practice. Intern Med J. 2010;40:828–32.PubMedCrossRef Karmakar G, Wilsher M. Use of the 'CURB 65' score in hospital practice. Intern Med J. 2010;40:828–32.PubMedCrossRef
80.
go back to reference Akram AR, Chalmers JD, Hill AT. Predicting mortality with severity assessment tools in out-patients with community-acquired pneumonia. QJM. 2011;104:871–9.PubMedCrossRef Akram AR, Chalmers JD, Hill AT. Predicting mortality with severity assessment tools in out-patients with community-acquired pneumonia. QJM. 2011;104:871–9.PubMedCrossRef
81.
go back to reference Bont J, Hak E, Hoes AW, et al. Predicting death in elderly patients with community-acquired pneumonia: a prospective validation study re-evaluating the CRB65 severity assessment tool. Arch Intern Med. 2008;168:1465–8.PubMedCrossRef Bont J, Hak E, Hoes AW, et al. Predicting death in elderly patients with community-acquired pneumonia: a prospective validation study re-evaluating the CRB65 severity assessment tool. Arch Intern Med. 2008;168:1465–8.PubMedCrossRef
82.
go back to reference McNally M, Curtain J, O'Brien KK, et al. Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis. Br J Gen Pract. 2010;60(579):e423–33.PubMedCrossRef McNally M, Curtain J, O'Brien KK, et al. Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis. Br J Gen Pract. 2010;60(579):e423–33.PubMedCrossRef
83.
go back to reference Francis NA, Cals JW, Butler CC, et al. Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care. Prim Care Respir J. 2012;21:65–70.PubMedCrossRef Francis NA, Cals JW, Butler CC, et al. Severity assessment for lower respiratory tract infections: potential use and validity of the CRB-65 in primary care. Prim Care Respir J. 2012;21:65–70.PubMedCrossRef
84.
go back to reference Silber SH, Garrett C, Singh R, et al. Early administration of antibiotics does not shorten time to clinical stability in patients with moderate-to-severe community-acquired pneumonia. Chest. 2003;124:1798–804.PubMedCrossRef Silber SH, Garrett C, Singh R, et al. Early administration of antibiotics does not shorten time to clinical stability in patients with moderate-to-severe community-acquired pneumonia. Chest. 2003;124:1798–804.PubMedCrossRef
85.
go back to reference Aliberti S, Di Pasquale M, Zanaboni AM, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis. 2012;54:470–8.PubMedCrossRef Aliberti S, Di Pasquale M, Zanaboni AM, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis. 2012;54:470–8.PubMedCrossRef
86.
go back to reference Aliberti S, Peyrani P, Filardo G, et al. Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia. Chest. 2011;140:482–8.PubMedCrossRef Aliberti S, Peyrani P, Filardo G, et al. Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia. Chest. 2011;140:482–8.PubMedCrossRef
87.
go back to reference Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest. 2008;134:955–62.PubMedCrossRef Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest. 2008;134:955–62.PubMedCrossRef
Metadata
Title
Hospital Admission Decision for Patients with Community-Acquired Pneumonia
Authors
Stefano Aliberti
Paola Faverio
Francesco Blasi
Publication date
01-04-2013
Publisher
Current Science Inc.
Published in
Current Infectious Disease Reports / Issue 2/2013
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-013-0323-7

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