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The outcome of non-hospital pneumonia depending on pre-hospital tactics during patient's first application for medical aid

Abstract number: 1134_03_113

Vertkin A., Naumov A.

Aim:  

Elaboration, introduction and evaluation of the effectiveness of clinical recommendations for treating patients with non-hospital pneumonia on the pre-hospital stage.

Methods:  

The research was carried out in 1081 patients with community acquired pneumonia (CAP). The patients were divided into 3 groups: I – 431, patients diagnosed with CAP, in a number of cases, was not confirmed while in hospital; II – 391,the tactics of treating CAP on the pre-hospital stage did not correspond to the clinical recommendations; III – 259 patients with confirmed CAP, the diagnosis of which and the pre-hospital treatment corresponded to the clinical recommendations. The patients of all the groups were comparable.

Results:  

On the pre-hospital stage the clinical picture was evaluated only in 4% of the patients, on average. The underestimation of the clinical picture caused hyper diagnostics of CAP on the pre-hospital stage, whereas in hospital, the absence of characteristic complaints and physical signs of CAP allowed to evaluate the situation adequately and to change the diagnosis. On the pre-hospital stage the patients of group II did not have the clinical criteria of CAP (70.3%)in the accompanying documents, their concomitant diseases were not revealed (81.4%), the anamnesis and data about the previous treatment were not collected, the adequate treatment of CAP was not carried out (antibacterial drugs were not administered in any of the cases). The risk of unfavorable termination was known to be not evaluated in 47% of the cases, and the hospitalization of more than one third of the patients was non-profile. Besides, the index of the pre-day lethality came to 12.1% and the general lethality came to 4.6%. in this group. In group III all the patients had the symptoms of CAP which allowed to evaluate the degree of the disease severity correctly, to administer the therapy of antibiotics – amoxicillin (Phlemoxin Solutab) in the case of non-severe pneumonia and ceftriaxon in case of severe pneumonia and to carry out correct sorting of the patients. The pre-day lethality came to 3.1% and the general lethality came to 2.3%. in this group. The time of group III patients’ stay in hospital came to 17 ± 3.4 days, and that of group II patients came to 21 ± 4.7 days (p ( 0.05). Moreover, the necessity of antibacterial therapy changing in group III, when in hospital, occurred only in 13.1% of the observation, whereas in group II it happened in 34.3% of the cases.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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