[Community-acquired pneumonia: impact of the use of a therapeutic strategy based on probability of short-term mortality].

BACKGROUND

To assess the impact of the use of a therapeutic strategy based on classifying patients with community-acquired pneumonia (CAP) according to the probability of short-term mortality.

PATIENTS AND METHODS

During one year, all patients admitted to the Emergency Department with diagnosis of CAP were included. Clinicians were invited to treat patients according to a recently published protocol that stratifies patients into five categories (from low to high-risk mortality): patients assigned to class 1 were managed at home; patients included in classes 2 and 3 were assigned to a short-time period at emergency department before managed at home; and patients assigned to classes 4 and 5 were hospitalized.

RESULTS

The final population analyzed included 101 patients. The rate of acceptability among clinicians was 96.7%. Patients were classified by the following terms: risk-class 1: 17 (16.8%); risk-classes 2 and 3: 40 (39.7%); risk-classes 4 and 5: 44 (43.6%). During follow-up, of the 57 non-hospitalized patients, 3 (5.2%) were subsequently admitted to hospital and 7 (12.2%) patients initially assigned to a short-time period at emergency department were hospitalized, and 1 (1.7%) of them died. By this program, the reduction of the hospitalization rate was 23.8%.

CONCLUSION

A strategy of management of CAP based on a prognostic classification has a good safety and acceptability among clinicians, and reduces the rate of hospitalizations.