MedWire News: One-quarter of individuals with community-acquired pneumonia (CAP) who are treated on an outpatient basis return to the emergency department (ED) within 30 days, show study findings from Canada.
"Few studies have been conducted in outpatients with pneumonia, and there is a paucity of data on short and long-term morbidity or mortality and associated clinical correlates in this group of patients," say Dean Eurich (University of Alberta, Edmonton) and co-authors.
"Understanding the prognosis for outpatients with CAP is crucial for optimizing their care," they add.
Over a 5-year period, the team followed up CAP patients presenting to seven EDs in Edmonton. Clinical data, including pneumonia severity index (PSI) scores, were collected at the time of presentation and 30-day morbidity and mortality were assessed.
Patients were defined as having CAP if they presented with two or more symptoms of cough, pleurisy, shortness of breath, a body temperature of 38oC or higher, crackles, or bronchial breathing on auscultation. Only patients with additional radiographic evidence of pneumonia were included in the study.
In total, 3874 patients with CAP were included in the study, with a final cohort of 3186 patients after excluding patients who died (n=9), and those who were admitted to hospital (n=274), returned to the ED on the same day of discharge (n=168), or who could not be linked to provincial administrative databases (n=237).
The majority (72%) of patients were 65 years of age or younger and had a very low predicted risk for 30-day mortality according to their PSI scores (88% in PSI risk class I-III).
The study also showed that patients with abnormal chest radiographs had similar characteristics to those with normal chest radiographs, although the PSI score suggested that they had slightly more severe pneumonia.
Overall, 35 (1%) patients died within 30 days of hospital discharge, of whom the majority (n=27) had a chest radiograph confirming pneumonia. Following hospital discharge, 25% of patients had at least one readmission to an ED within 30 days. In addition, 8% of patients were admitted to hospital within 30 days.
"Given the long-term follow-up data available, we will also be able to fully examine the impact of an episode of pneumonia on long-term sequelae, healthcare resource use, and prognostic factors associated with improved or adverse outcomes including recurrent episodes of pneumonia," conclude the authors in BMC Infectious Diseases.
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