Assessing decision of inpatient or outpatient care in community acquired pneumonia patients: Results of APT care study
Abstract
Background: An important decision in managing Community Acquired Pneumonia (CAP) patients relates to their hospitalization. CURB 65 (Confusion, Urea, Respiratory rate, Blood pressure, age ≥ 65 years), a prediction tool helps in decision making. This study estimates the proportion of CAP patients with disagreement between CURB 65 recommendation and physician's decision to hospitalize/not hospitalize.
Methods: This cross-sectional multicentre study recruited consenting adult patients with a confirmatory diagnosis of CAP on Chest X-ray. CURB 65 recommendation for each patient was determined at the time of data analysis. This recommendation was compared with treatment decision made by the physician. Disagreement (expressed as a proportion) was considered when the physician's decision did not match with the recommendation.
Results: Between December 2011 and May 2012, 22 investigators across ten cities in Pakistan gathered information on 352 eligible patients (57.1% males, mean age: 50.7 (±18.5) years). In 40% (140/352) patients there was a disagreement between CURB-65 recommendation and physician's decision of hospitalization or outpatient care. Of the 352 cases 37.5% (132) were hospitalized despite CURB 65 recommendation of outpatient treatment. Levofloxacin was the most commonly (15%) prescribed mono therapeutic agent whereas ceftriaxone was commonly (30%) prescribed in combination therapy.
Conclusion: In this first nation-wide study in four out of ten patients there was…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 352 participants or records.
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