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?

Llorens Soriano P, Murcia J, Laghzaoui F, Martínez-Beloqui E, Pastor Cesteros R, Marquina V, Ramos S, Jiménez I, Landete I, Román Cerdá F, Albert-Jiménez A

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 of 1 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 was 2.2 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.

Conclusions: Patients with community-acquired pneumonia classified as being at high

risk (older patients, with functional decline, comorbidity, multilobar infiltrates, sensory

abnormalities, and elevated lactate levels) are most often admitted to the short-stay unit

and internal medicine department. A large percentage of community-acquired

pneumonia patients in low-risk classes are admitted to hospital.

Albert-Jiménez A, Jiménez I, Laghzaoui F, Landete I, Llorens Soriano P, Marquina V, Martínez Beloqui E, Murcia J, Pastor Cesteros R, Ramos S, Román Cerdá F