Patient Stratification and Decision to Hospitalize Patients with Community-Acquired Pneumonia

Kwan-Ho Lee

doi:10.5124/jkma.2007.50.10.868

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Lee: Patient Stratification and Decision to Hospitalize Patients with Community-Acquired Pneumonia

Focused Issue of This Month

Community-Acquired Pneumonia

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2007; 50(10): 868-876.

Published online: 31 October 2007

DOI: https://doi.org/10.5124/jkma.2007.50.10.868

Patient Stratification and Decision to Hospitalize Patients with Community-Acquired Pneumonia

Kwan-Ho Lee, MD

Department of Internal Medicine, Yeungnam University College of Medicine, Korea. ghlee@med.yu.ac.kr

Abstract

Patients with community-acquired pneumonia can be divided into four groups, each with a list of likely pathogens and suggested empiric therapy accordingly. Patient classification is based on the assessment of place of therapy, the presence of cardiopulmonary disease, and the presence of modifying factors. The admission decision remains to be difficult and follows the prognostic scoring rules (the Pneumonia Patients Outcome Research Team, PORT) are widely using as admission criteria. Still clinicians use inconsistent admission criteria and often overestimate patients risk. In general, hospitalization is needed if patients have multiple risk factors for a complicated course. Admission to the intensive care unit is needed for patients with severe community-acquired pneumonia.

Keywords: Community-acquired pneumonia, Classification, Hospitalization decision

Figures and Tables

Figure 1

Prediction rule to identify patients with community-acquired pneumonia.

Figure 2

Severity assessment in a hospital setting: the CURB-65 score. One step strategy for stratifying patients with community-acquired pneumonia risk groups according to risk of mortality at 30 days when the results of blood urea are available.

Table 1

Four patients groups according to American Thoracic Society community-acquired pneumonia guidelines

Table 2

Group I: outpatients, no cardiopulmonary disease, no modifying factors *, †

^*Excludes patients at risk for HIV

^†In roughly 50~90% of the cases no etiology was identified

Table 3

Group II: outpatients, with cardiopulmonary disease, and/or other modifying factors *, †

^*Excludes patients at risk for HIV

^†In roughly 50~90% of the cases no etiology was identified

Table 4

Group III: inpatients, not in intensive care unit *, †

^*Excludes patients at risk for HIV

^†In roughly one-third to one-half of the cases no etiology was identified

Table 5

Group IV: intensive care unit-admitted patients *, †

^*Excludes patients at risk for HIV

^†In roughly one-third to one-half of the cases no etiology was identified

Table 6

Risk factors to hospitalize patients with community-acquired pneumonia

^*Predict mortality in the PORT prediction rule model

Table 7

Pneumonia Patients Outcomes Research Team(PORT) Pneumonia Severity Index (PSI)

^*Or an oxygen saturation of < 90 percent on pulse oximetry

Table 8

Class and mortality according to Pneumonia Severity Index

Table 9

Definition of severe community-acquired pneumonia

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