APPROPRIATENESS OF HOSPITALIZATION OF PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Study objective: To investigate the association between the appropriat eness of hospitalization and the course of hospitalization in patients with community-acquired pneumonia (CAP). Methods: We carried out a pr ospective study of 346 adult patients hospitalized with community-acqu ired pneumonia (CAP). Appropriateness of hospitalization was assessed with a modified appropriateness evaluation protocol (AEP) based on vit al signs and laboratory tests. Hospitalizations that ended in death, l asted more than 4 days, or involved resuscitation, intubation, monitor ing, or supplemental oxygen therapy were considered complicated. Resul ts: According to the AEP protocol, hospitalization was not appropriate for 210 of the 346 patients (61%). However, AEP proved to be an insen sitive tool for the identification of patients with complicated hospit al courses. Half of the 346 patients had complicated courses, includin g 82 of the 210 patients with inappropriate hospitalization (39%), acc ording to the AEP. Four independent factors, age greater than 50 years , female sex, no antibiotic treatment before hospitalization, and more than 4 days of illness before admission predicted a complicated cours e in patients with inappropriate hospitalization as determined with th e AEP criteria. Conclusion: It is important to avoid the unnecessary h ospitalization of patients with CAP. However, this should not be achie ved at the expense of unjustified discharge from the emergency departm ent. In the decision to hospitalize, additional prognostic factors, su ch as those presented here, should be taken into consideration to impr ove the admission process. This is particularly relevant for cases in which the AEP is invalid and indications for hospitalization are not c lear cut. In these patients, a simpler and more precise scoring system should be developed.