Community-acquired pneumonia in adults: Assessing severity and determining the appropriate site of care
- Donald M Yealy, MD, FACEP
Donald M Yealy, MD, FACEP
- Professor and Chair of Emergency Medicine
- University of Pittsburgh
- Michael J Fine, MD, MSc
Michael J Fine, MD, MSc
- Professor of Medicine
- University of Pittsburgh and VA Pittsburgh Healthcare System
Community-acquired pneumonia (CAP) is a common and potentially serious illness, accounting for the single largest group of sepsis-triggering events. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with coexisting comorbidities. (See "Prognosis of community-acquired pneumonia in adults".)
Hospital admission rates in the United States for adults with CAP vary widely and are often not directly related to local disease severity, suggesting that clinicians use inconsistent criteria when making the initial decision about the appropriate site of care. In addition, clinicians often overestimate patient risk of short-term mortality, even among low-risk patients . A likely consequence of these overestimates is unnecessary admissions; low-risk patients with a physician-estimated risk of death in excess of 5 percent were over six times more likely to be hospitalized after adjusting for other potential confounders of hospitalization .
This topic review focuses on clinical prediction rules and practice guidelines to determine the initial site of treatment for CAP and to avoid unnecessary hospitalizations.
A variety of other important issues related to CAP are discussed separately. These include:
●The diagnostic approach to patients with CAP. (See "Diagnostic approach to community-acquired pneumonia in adults".)
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- APPROACH TO SITE OF CARE
- CLINICAL PREDICTION RULES FOR SEVERITY
- Pneumonia Severity Index
- - Results
- - Effectiveness and safety of the PSI as a decision aid
- - Additional options for site of care
- - Limitations of using the PSI as a decision aid
- - Other applications of the PSI
- CURB-65 and CRB-65 scores
- - Comparison to PSI
- Scores to identify severe CAP
- - SCAP
- - SMART-COP
- - IDSA/ATS severity criteria
- PRACTICE GUIDELINES
- Site of treatment
- Admission to intensive care
- IMPORTANCE OF OXYGEN SATURATION
- NURSING HOME RESIDENTS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS