Chest
Clinical InvestigationsInfectionsHospitalization for Community-Acquired Pneumonia: The Pneumonia Severity Index vs Clinical Judgment
Section snippets
Materials and Methods
We conducted a retrospective observational study of patients who had been hospitalized between October 1997 and May 2000 with a diagnosis of CAP at the University of Louisville Hospital and the Veterans Affairs Medical Center of Louisville, KY. CAP was defined by the presence of a new pulmonary infiltrate (according to the radiology report) plus at least one of the following: fever; new or increased cough; leukocytosis; or leukopenia. The pneumonia severity index was calculated as previously
Results
A total of 328 patients fulfilled our criteria for CAP. The number of patients in each risk class was as follows: risk class I, 42 patients (12%); risk class II, 44 patients (13%); risk class III, 87 patients (27%); risk class IV, 110 patients (34%); and risk class V, 45 patients (14%). The total number of patients in risk classes I and II was 86 (26%). For patients with a risk class of I, the mean age was 41.1 years, and the average length of hospital stay was 4.6 days. For patients with a
Discussion
We found that the majority of patients who had been admitted to the hospital for CAP with a pneumonia severity index class of I or II had extenuating clinical circumstances to justify their admission. Disease comorbidities and unmet social needs were the major categories of clinical factors justifying hospital admission for these patients. Used as the sole indicator for inappropriate hospitalization, the pneumonia severity index had a poor positive predictive value of only 16%.
Our findings
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