Factors Influencing the Hospital Admission Decision of Low-Risk Patients with Community Acquired Pneumonia: Evaluating the Usefulness of a Prediction Rule

Abstract

Introduction The Pneumonia Patient Outcomes Research Team (PORT) derived and validated a Prediction Rule to identify low-risk patients with community-acquired pneumonia (CAP).1 This prediction rule was implemented in the Accident & Emergency (A&E) Department of Prince of Wales Hospital to help select patients suitable for outpatient treatment. Materials & Methods A retrospective study of all cases of CAP admitted from A&E, age above 14, over a six-month period (the period of implementation of the Prediction Rule) was performed. Patients belonging to the low-risk categories were identified after review of the records. Factors likely to influence the admission decision were noted. Descriptive statistics was generated. Results Eighty-five patients were identified, 61 (71.8%) females and 24 (28.2%) males. The mean age was 59.1 years (±17.3 years, SD). Fifty-three (62.3%) patients had at least one significant comordid condition (e.g. chronic lung disease, diabetes). Of the remaining patients, 20 (23.5%) had at least one identifiable factor (e.g. haemoptysis, multilobar infiltrates in chest radiograph) influencing the hospitalisation decision; and only 12 (14.1%) had no reason, identifiable retrospectively, to justify hospitalised care. Conclusions A substantial number of low-risk patients with CAP (classified according to the Prediction Rule) were admitted. Most of these patients had identifiable comorbid conditions and prognostic factors that had not been accounted for by the Prediction Rule guidelines. Further evaluation of the significance of these additional variables is required in order to give the guidelines a better predictive value.