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This Article Full Text (PDF) All Versions of this Article: chest.07-1456v1 133/3/610    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal 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 Google Scholar Google Scholar Articles by Restrepo, M. I. Articles by Anzueto, A. Search for Related Content PubMed PubMed Citation Articles by Restrepo, M. I. Articles by Anzueto, A. Related Content Related Editorial

A comparative study of community-acquired pneumonia patients admitted to the Ward and the Intensive Care Unit

VERDICT (EMM and MIR), South Texas Veterans Health Care System Audie L Murphy Division (EMM, AA and MIR), and the University of Texas Health Science Center at San Antonio, Department of Pharmacology (CF); Department of Medicine, Divisions of General Medicine (JAV and EMM) and Pulmonary and Critical Care Medicine (MIR and AA)

restrepom{at}uthscsa.edu

Abstract

Background: Limited information is available on health care utilization of hospitalized patients with community-acquired pneumonia (CAP) depending on the location of care. Our aim was to compare the clinical characteristics, etiology and outcomes of patients with CAP admitted to the ICU with those admitted to the ward service.

Methods: A retrospective cohort study, at two tertiary teaching hospitals, VA hospital and a county hospital. Eligible subjects were admitted with a diagnosis of CAP between 1/1/1999 and 12/31/2001, had a confirmatory chest x-ray, and discharge ICD-9 diagnosis of pneumonia. Subjects were excluded if they were "comfort measures only" or transferred from another acute care hospital or nursing home patients. Bivariate and multivariable analysis evaluated 30- and 90-day mortality as the dependent measure.

Results: Data were abstracted on 730 patients (ICU=145 and 585=wards). Compared to ward, ICU patients were more likely to be male (P=0.001), have congestive heart failure (P=0.01) and chronic obstructive pulmonary disease (P=0.01). ICU patients also had higher pneumonia severity index scores (mean (SD) 112 (35) vs. 83 (30), P=0.02). Patients admitted to the ICU patients had longer length of hospital stay (mean (SD); 12 (10) days vs. 7 (17); P=0.07), higher 30- (23% vs. 4%; P<0.001) and 90-day mortality (28% vs. 8%; P<0.001) compared to ward patients.

Conclusions: ICU patients present with more severe disease and more comorbidities. ICU patients stay longer in the hospital and have a much higher mortality when compared to ward patients. Management strategies should be designed to improve clinical outcomes in ICU patients.

Key Words: Pneumonia • Intensive care units • Outcome and process assessment • Critical care • Mortality • Microbiology

Related Editorial

There Is No "Cap" on the Importance of Community-Acquired Pneumonia in the ICU

Andrew F. Shorr and Richard G. Wunderink
Chest 2008 133: 590-592. [Full Text] [PDF]

This article has been cited by other articles:

				A. F. Shorr and R. G. Wunderink There Is No "Cap" on the Importance of Community-Acquired Pneumonia in the ICU Chest, March 1, 2008; 133(3): 590 - 592. [Full Text] [PDF]