Journal Article

Routine Use of the Pneumonia Severity Index for Guiding the Site-of-Treatment Decision of Patients with Pneumonia in the Emergency Department: A Multicenter, Prospective, Observational, Controlled Cohort Study

Bertrand Renaud, Eva Coma, Jose Labarere, Jan Hayon, Pierre-Marie Roy, Hélène Boureaux, Fabienne Moritz, Jean François Cibien, Thomas Guérin, Emmanuel Carré, Armelle Lafontaine, Marie Pierre Bertrand, Aline Santin, Christian Brun-Buisson, Michael J. Fine and Eric Roupie

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 1, pages 41-49
Published in print January 2007 | ISSN: 1058-4838
Published online January 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/509331
Routine Use of the Pneumonia Severity Index for Guiding the Site-of-Treatment Decision of Patients with Pneumonia in the Emergency Department: A Multicenter, Prospective, Observational, Controlled Cohort Study

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Background. Although the Pneumonia Severity Index (PSI) has been extensively validated, little is known of the impact of its routine use as an aid to site-of-treatment decisions for patients with pneumonia who present to emergency departments (EDs).

Methods. A prospective, observational, controlled cohort study of patients with pneumonia was conducted in 8 EDs that used the PSI (PSI-user EDs) and 8 EDs that did not use the PSI (PSI-nonuser EDs) in France. The outcomes examined included the proportion of “low-risk” patients (PSI risk classes I–III) treated as outpatients, all-cause 28-day mortality, admission of inpatients to the intensive care unit, and subsequent hospitalization of outpatients.

Results. Of the 925 patients enrolled in the study, 472 (51.0%) were treated at PSI-user EDs, and 453 (49.0%) were treated at PSI-nonuser EDs; 449 (48.5%) of all patients were considered to be at low risk. In PSI-user EDs, 92 (42.8%) of 215 patients at low risk were treated as outpatients, compared with 56 (23.9%) of 234 patients at low risk in PSI-nonuser EDs. The adjusted odds ratios for outpatient treatment were higher for patients in PSI risk classes I and II who were treated in PSI-user EDs, compared with PSI-nonuser EDs (adjusted odds ratio, 7.0 [95% confidence interval, 2.0–25.0] and 4.6 [95% confidence interval, 1.3–16.2], respectively), whereas the adjusted odds ratio did not differ by PSI-user status among patients in risk class III or among patients at high risk. After adjusting for pneumonia severity, mortality was lower in patients who were treated in PSI-user EDs; other safety outcomes did not differ between patients treated in PSI-user and PSI-nonuser EDs.

Conclusions. The routine use of the PSI was associated with a larger proportion of patients in PSI risk classes I and II who had pneumonia and who were treated in the outpatient environment without compromising their safety.

Journal Article.  4648 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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