Epidemiologic study of community-acquired pneumonia treated at a tertiary-care hospital: Does Fine’s pneumonia severity index influence decision-making in the emergency department?

ABSTRACT

Objectives: To determine the incidence of community-acquired pneumonia and describe its characteristics. To assess differences influenced by Fine’s pneumonia severity index. Methods: Prospective, descriptive study of patients with community-acquired pneumonia treated over a period of1 year in the emergency department of Hospital General Universitario in Alicante, Spain. Social, demographic and clinical variables (including laboratory, radiologic, and microbiologic data) were collected. Destination on discharge from the emergency department and patient status at 30 days were recorded. The pneumonia severity index was determined according to Fine’s prediction rule, and patients were then classified as being at low (< III) or high (> III) risk. Differences between the 2 risk classes and the distribution of admissions according to risk were analyzed. Results: Five hundred fifty patients with community-acquired pneumonia were included. The cumulative incidence was2.2 cases per 1000 patient-years. Patients with community-acquired pneumonia at high risk had more comorbidity and functional decline, a higher incidence of respiratory failure, and infiltrates in multiple lobes. An etiologic diagnosis was established for 209 patients (38%). The most common microorganism isolated was Streptococcus pneumoniae in all risk classes. The admission rate was 77.2% (high-risk classes, 99.5%; low-risk, 65.1%). The patients were admitted to the respiratory medicine department, the short-stay unit, and the internal medicine department. Risk class influenced patient destination on discharge from the emergency department (AU)

RESUMEN

Objetivo: Conocer la incidencia y características clínicas de los pacientes con neumonía adquirida en la comunidad (NAC) y reflejar las diferencias en función de la gravedad determinada por el índice de Fine (IF).Método: Estudio descriptivo y prospectivo de los pacientes con NAC atendidos en el servicio urgencias (SU) del Hospital General Universitario de Alicante durante un año. Se recogieron variables sociodemográficas, clínicas, analíticas, radiológicas, microbiológicas y relacionadas con el destino al alta. Se realizó seguimiento a los 30 días. Se determinó la gravedad de la NAC según el IF, y se clasificó en NAC de bajo riesgo (..) (AU)