Jcg. Simpson et al., A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales, THORAX, 55(12), 2000, pp. 1040-1045
Background-The aim of this study was to describe the frequency, causal path
ogens, management, and outcome of a population of young adults who died fro
m community acquired pneumonia (CAP).
Methods-Pneumonia deaths in England and Wales in adults aged 15-44 were ide
ntified between September 1995 and August 1996. Patients with underlying ch
ronic illness including HIV infection were excluded. Clinical details for e
ach case were collected from the hospital and general practitioner records.
Results-Death from CAP was identified in 27 previously well young adults (1
.2 per million population per year). Twenty were known to have consulted a
GP for this illness. Nine received antibiotics before hospital admission. A
causative pathogen was identified in 17 cases (Streptococcus pneumoniae in
eight). Bacteraemia was present in seven. All patients who reached a hospi
tal ward received antibiotics (69% within two hours of admission). The Brit
ish Thoracic Society antibiotic guidelines for severe CAF were followed in
only 10 cases. Cardiac arrest at home or on arrival at hospital occurred in
six cases, one of whom was successfully resuscitated. Of the remaining 21
patients, 71% had two or more markers of severe CAP. All 22 who were admitt
ed reached an intensive care unit, but 11 of these required transfer to ano
ther hospital for some aspect of intensive care. One third of patients died
within 24 hours of presenting to the hospital.
Conclusions-Death from CAP in previously fit young adults still occurs. Whi
le some deaths might be preventable by management, most are unlikely to be
preventable by current management practices.