The application of a validated risk score safely reduces the rate of hospital admission in patients with community-acquired pneumonia presenting to the emergency department
Abstract number: 1134_03_120
Richeldi L., Marchetti F., De Guglielmo M., Giovanardi D., Fabbri L.
Patients receiving a diagnosis of community acquired pneumonia (CAP) in the hospital Emergency Department (ED) need to be carefully evaluated to be treated as in- or out-patients. The Pneumonia Score Index (PSI) is a validated score predicting the short term risk of death in patients with CAP and could therefore assist in deciding whether a single patient with CAP needs to be hospitalized or not.
We implemented a computer-based critical decision pathway for the management of patients with CAP, based on the PSI score and a dedicated software (GesPOrEx©). Briefly, all adults aged >18 years with provisional diagnosis of CAP were eligible for inclusion in the study. All patients received written information about their diagnosis of pneumonia and their treatment plan. CAP was defined as the presence of new pulmonary infiltrate on chest Rx and symptoms consistent with pneumonia, including cough, dyspnea, change in sputum, pleuritic chest pain. The PSI score was then calculated for all patients meeting eligibility criteria. Patients with scores of 90 points or lower were recommended for outpatients treatment, whereas those with higher scores were recommended for hospital admission. The PSI score was used only as a guide to the admission decision and did not superseded clinical judgment. The follow-up consisted of two visits, within 10 days and about 1 month after discharge from the hospital.
The protocol was applied to 117 consecutive patients with CAP presenting at our ED. Compared to the previous year, we detected a significant 37% reduction (p < 0.001, 95% CI 2649%) in the rate of admissions to the hospital of patients with CAP. Moreover, the length of stay in the hospital showed a trend toward reduction (from 9 ± 2 days before protocol implementation, to 7 ± 5 days). In the 3 months follow up, we did not detect any re-hospitalization in patients treated as out-patients and the rate of cure was similar before and after the protocol implementation.
We estimated that the application of this critical pathway generated a potential saving of about 110.00 Euros in one year. Interestingly, after the study end the trend towards a reduction in admission rate for CAP patients was maintained, thus suggesting that the use of the PSI score entered clinical practice with persistent beneficial effects on clinically safe and cost-effective management of CAP patients.
|Session name:||XXIst ISTH Congress|
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