Sharon See

Assessing the Validity of Community Acquired Pneumonia Hospital Admissions

Sharon See, College of Pharmacy and Health Sciences, Department of Clinical Pharmacy Practice; Leslie Hsiung, Stacy De-Lin, Marika Alois, James Mumford, Yvette Schlussel, Beth Israel Medical Center, Institute for Family Health

Abstract

Objectives: The CURB-65 score is a severity assessment of community acquired pneumonia (CAP) based on five factors: Confusion, Urea (blood urea nitrogen) > 7mmol/L or 20mg/dL, Respiratory rate > 30 breaths/minute, Blood pressure, systolic < 90mmHg or diastolic <60mmHg, Age > 65 years. Scores >2 justify hospitalization. The objective of this study was to evaluate CAP patients at the time of admission to determine adherence to CURB-65 criteria and identify other risk factors that contributed to the decision for inpatient admission. Other objectives included identification of complications that occurred in patients with CURB scores <2 and length of stay information.

Methods: This was a retrospective chart review of 72 Family Medicine inpatients over the age of 18 years admitted for CAP at Beth Israel Medical Center during the period from January 1, 2009 to December 31, 2011.

Results: An initial search in our FileMaker Pro database identified 173 patients with a diagnosis of CAP for this time period. Ninety-two patients were eligible based on inclusion/exclusion criteria but only 72 had sufficient data to permit analysis. Two-thirds of the patients who were admitted did not fulfill CURB 65 admission requirements. There were no significant reasons for admitting patients with CURB scores <2. Complications developed during stay were minor and not significantly different between groups. Patients with CURB scores <2 had an average length of stay of 5 days and were, on average, younger (65 vs 75, respectively).

Conclusions: Most CAP patients admitted to our hospital could have been treated as outpatients according to CURB 65 criteria.