Hospitalization decision in patients with community-acquired pneumonia: A prospective cohort study

摘要: Abstract purpose: To identify a low-risk subset of patients with community-acquired pneumonia that could safely be treated in the ambulatory setting; and to assess how clinicians make hospitalization decision. methods: We performed prospective, observational study 280 hospitalized adults clinical radiographic evidence pneumonia. Patients were followed all potential morbid complications 6-week mortality. Physicians responsible for managing these surveyed reasons treating hospital or setting therapies dictate hospitalization. results: Sixty-one percent (170 280) did not have an indication admission at presentation using modified Appropriateness Evaluation Protocol criteria (a severe vital sign abnormality, alteration mental status, suppurative complication, arterial hypoxemia, laboratory acute coexistent medical problem requiring independent pneumonia). Among 170 patients, 38% had complicated course defined as death within 6 weeks, development new complication due pneumonia, intensive care unit admission, persistent fever use intravenous fluids oxygen beyond 3 days, lasting more than subsequent initially setting. Five predisposing factors identified logistic regression models. The odds ratio age 65 years was 2.7; comorbid illness, 3.2; temperature 38.3°C (101°F), 4.1; immunosuppression, 12.0; high-risk etiology, 23.3. risk increased linearly number factors, from 12% none 100% four (p conclusions: If validated, our findings improve physicians' assessment prognosis, may who managed