Characteristics of low-risk patients hospitalized with community-acquired pneumonia

Etzion, O.; Novack, V.; Avnon, L.; Porath, A.; Dagan, E.; Riesenberg, K.; Avriel, A.; Schlaeffer, F.

doi:10.1016/j.ejim.2006.10.003

« Previous Next »European Journal of Internal Medicine
Volume 18, Issue 3 , Pages 209-214, May 2007

Characteristics of low-risk patients hospitalized with community-acquired pneumonia

O. Etzion
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
- O. Etzion and V. Novack contributed equally to the study.
V. Novack
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
- Harvard Clinical Research Institute, Boston, USA
- Corresponding author. Harvard Clinical Research Institute, 930 Commonwealth Ave., 3rd Floor, Boston, MA 02215, USA. Tel.: +1 617 632 1367; fax: +1 617 632 1580.
- O. Etzion and V. Novack contributed equally to the study.
L. Avnon
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
A. Porath
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
E. Dagan
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
K. Riesenberg
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
A. Avriel
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
F. Schlaeffer
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel

Received 17 June 2006; received in revised form 28 September 2006; accepted 10 October 2006.

Abstract

Background

Despite the wide distribution of different severity scoring systems for community-acquired pneumonia (CAP) patients, low-risk patients are frequently hospitalized, contrary to current recommendations. The aim of our study was to determine the rate, clinical characteristics, and outcome of low-risk patients with CAP admitted to our institution.

Methods

During an 18-month period, we prospectively screened all patients admitted to the Division of Internal Medicine with a presumptive diagnosis of CAP. Pneumonia Outcome Research Team (PORT) score and pneumonia severity index (PSI) were calculated for all patients during the first 24 h.

Results

A total of 591 patients had a diagnosis of CAP. Some 196 patients (33.1%) were low-risk (PSI class I, II), 98 (16.6%) intermediate (PSI III), and 297 (50.3%) high-risk patients (PSI IV, V). Patients in low-risk classes were younger (45.5±15.8 vs. 65.0±12.5 and 74.9±11.8 years, respectively, p<0.001) and had fewer background diseases. They had shorter hospitalizations than intermediate- and high-risk groups (4.4±3.2, 5.3±3.4, and 6.8±6.4 days, respectively, p<0.001). There was a significant difference in 30-day mortality between the different risk groups: 0% in the low-risk, 2.0% in the intermediate-risk, and 9.4% in the high-risk group (p<0.001).

Conclusion

The considerable proportion of low-risk patients hospitalized due to CAP was found to be comparable to the stable 30% rate reported in the literature. We conclude that physicians tend to opt for a wide safety range when considering a CAP patient hospitalization, rather than make a decision based only on severity score calculation.

Keywords: Community-acquired pneumonia, Hospitalization, Risk score