HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (36) Citing Articles via Google Scholar Google Scholar Articles by Marras, T. K. Articles by Chan, C. K. Search for Related Content PubMed PubMed Citation Articles by Marras, T. K. Articles by Chan, C. K.

Applying a Prediction Rule To Identify Low-Risk Patients With Community-Acquired Pneumonia^*

^* From the Division of Respirology, Department of Medicine, The University Health Network, University of Toronto, Toronto, Canada.

Correspondence to: Charles K. Chan, MD, FCCP, Division of Respirology, Toronto General Hospital, University Health Network, 10EN-220, 200 Elizabeth St, Toronto ON M5G 2C4, Canada; e-mail: charles.chan{at}uhn.on.ca

Study objectives: To study the validity of a recently developed community-acquired pneumonia (CAP) severity prediction rule in estimating mortality, to determine its utility in decision making regarding hospitalization, and to assess factors influencing this decision.

Design: Retrospective chart review.

Setting: Two sites of the University Health Network, the Toronto General and Toronto Western Hospitals, tertiary-care teaching institutions with a sizable primary-care and secondary-care source of referrals, and a total of 900 beds.

Patients: Consecutive patients with CAP admitted between February and June 1996.

Measurements and results: A single trained medical records extractor assembled data to compare our population to that used in developing the CAP prediction rule, in terms of mortality and to assess reasons for hospitalization. Two hundred fifty-five eligible patients were admitted, and 244 charts (96%) were available. Our patients tended to be older, with nearly four times as many residents of chronic care institutions (39% compared with 10%), and had a higher risk class distribution than the published cohort. Risk class-specific mortality was similar in four of five classes. Of the 71 patients in the low-risk classes, 67 had additional reasons for admission; 18 of which were psychosocial (homelessness, substance abuse, or inadequate home supports).

Conclusions: The CAP severity prediction rule estimates mortality well. Admission of low-risk patients was linked to psychosocial and other medical reasons not captured by this rule. The rule can be very useful in assessing the need for hospitalization; however, there remains a significant percentage of patients with a low severity score who may require hospitalization for psychosocial and economic considerations.

Key Words: aged • clinical prediction rules • guidelines • hospitalization • mortality • prognosis • risk • socioeconomic factors

This article has been cited by other articles:

				A. Capelastegui, P. P. Espana, J. M. Quintana, I. Areitio, I. Gorordo, M. Egurrola, and A. Bilbao Validation of a predictive rule for the management of community-acquired pneumonia Eur. Respir. J., January 1, 2006; 27(1): 151 - 157. [Abstract] [Full Text] [PDF]

				M. Woodhead, F. Blasi, S. Ewig, G. Huchon, M. Leven, A. Ortqvist, T. Schaberg, A. Torres, G. van der Heijden, and T. J. M. Verheij Guidelines for the management of adult lower respiratory tract infections Eur. Respir. J., December 1, 2005; 26(6): 1138 - 1180. [Abstract] [Full Text] [PDF]

				J. Carratala, N. Fernandez-Sabe, L. Ortega, X. Castellsague, B. Roson, J. Dorca, A. Fernandez-Aguera, R. Verdaguer, J. Martinez, F. Manresa, et al. Outpatient Care Compared with Hospitalization for Community-Acquired Pneumonia: A Randomized Trial in Low-Risk Patients Ann Intern Med, February 1, 2005; 142(3): 165 - 172. [Abstract] [Full Text] [PDF]

				C. H. Goss, G. D. Rubenfeld, D. R. Park, V. L. Sherbin, M. S. Goodman, and R. K. Root Cost and Incidence of Social Comorbidities in Low-Risk Patients With Community-Acquired Pneumonia Admitted to a Public Hospital Chest, December 1, 2003; 124(6): 2148 - 2155. [Abstract] [Full Text] [PDF]

				F. W. Arnold, J. A. Ramirez, L. C. McDonald, and E. L. Xia Hospitalization for Community-Acquired Pneumonia: The Pneumonia Severity Index vs Clinical Judgment Chest, July 1, 2003; 124(1): 121 - 124. [Abstract] [Full Text] [PDF]

				M Woodhead Assessment of illness severity in community acquired pneumonia: a useful new prediction tool? Thorax, May 1, 2003; 58(5): 371 - 372. [Full Text] [PDF]

				P.P. Espana, A. Capelastegui, J.M. Quintana, A. Soto, I. Gorordo, M. Garcia-Urbaneja, and A. Bilbao A prediction rule to identify allocation of inpatient care in community-acquired pneumonia Eur. Respir. J., April 1, 2003; 21(4): 695 - 701. [Abstract] [Full Text] [PDF]

				M. Woodhead Community-acquired pneumonia guidelines: much guidance, but not much evidence Eur. Respir. J., July 1, 2002; 20(1): 1 - 3. [Full Text] [PDF]

				A. Ortqvist Treatment of community-acquired lower respiratory tract infections in adults Eur. Respir. J., July 1, 2002; 20(36_suppl): 40S - 53s. [Abstract] [Full Text] [PDF]

				Clinical Prediction Rules for Pneumonia Don't Consider the Entire Picture Journal Watch Emergency Medicine, January 4, 2001; 2001(104): 3 - 3. [Full Text]

eLetters: