AN ANALYSIS OF DECISIONS BY EUROPEAN GENERAL-PRACTITIONERS TO ADMIT TO HOSPITAL PATIENTS WITH LOWER RESPIRATORY-TRACT INFECTIONS

Background - The purpose of this study was to identify factors on whic h European general practitioners (GPs) base their decisions to admit t o hospital patients with lower respiratory tract infections (LRTI). Me thods - A survey was carried out from December 1993 to January 1994 to identify factors that affect GPs' decisions to admit to hospital pati ents with LRTI by collecting data on 2056 patients from 605 GPs in Fra nce, Germany, Italy, Spain, and the UK. Results - Only 93 (4.5%) of th e patients included in the study were admitted to hospital. Univariate analysis showed that age > 60 years, institutionalisation of the pati ent, concomitant diseases, cardiac insufficiency, asthma, a diagnosis of pneumonia, and clinical signs such as chest pain, cyanosis, tachypn oea and hypotension significantly (odds ratio (OR) > 2.0, p < 0.002) i nfluenced the decision to admit to hospital. No influence could be sho wn for sex, smoking habits, history of bronchiectasis or chronic bronc hitis, the presence of fever, chills, myalgia, cough or purulent sputu m, and the diagnoses of acute bronchitis, influenza or exacerbation of chronic bronchitis. In the multivariate analysis only the presence of chest pain (OR 2.3, 95% confidence interval (CI) 1.5 to 3.5), cyanosi s (OR 4.1, 95% CI 2.4 to 7.1), dyspnoea (OR 4.9, 95% CI 3.1 to 7.9), a nd hypotension (OR 2.9, 95% CI 1.6 to 5.2), as well. as a diagnosis of pneumonia (OR 6.6, 95% CI 4.3 to 10) (all p < 0.00001) remained as fa ctors that significantly affected the decision to admit to hospital. C onclusions - Clinical signs of severe infection and a diagnosis of pne umonia are the main factors that induce GPs to admit patients with LRT I to hospital in Europe.