Feagan B G, Marrie T J, Lau C Y, Wheeler S L, Wong C J, Vandervoort M K
London Clinical Trials Research Group, John P. Robarts Research Institute, ON.
CMAJ. 2000 May 16;162(10):1415-20.
Community-acquired pneumonia is a common disease with a large economic burden. We assessed clinical practices and outcomes among patients with community-acquired pneumonia admitted to Canadian hospitals.
A total of 20 hospitals (11 teaching and 9 community) participated. Data from the charts of adults admitted during November 1996, January 1997 and March 1997 were reviewed to determine length of stay (LOS), admission to an intensive care unit and 30-day in-hospital mortality. Multivariate analyses examined sources of variability in LOS. The type and duration of antibiotic therapy and the proportion of patients who were treated according to clinical practice guidelines were determined.
A total of 858 eligible patients were identified; their mean age was 69.4 (standard deviation 17.7) years. The overall median LOS was 7.0 days (interquartile range [IQR] 4.0-11.0 days); the median LOS ranged from 5.0 to 9.0 days across hospitals (IQR 6.0-7.8 days). Only 22% of the variability in LOS could be explained by known factors (disease severity 12%; presence of chronic obstructive lung disease or bacterial cause for the pneumonia 2%; hospital site 7%). The overall 30-day mortality was 14.1% (95% confidence interval [CI] 11.8%-16.6%); 13.6% of the patients were admitted to an intensive care unit (95% CI 11.4%-16.1%). The median duration of intravenous antibiotic therapy was 5 days (range 3.0-6.5 days across hospitals). Although 79.8% of patients received treatment according to clinical practice guidelines, the rate of compliance with the guidelines ranged from 47.9% to 100% across hospitals.
Considerable heterogeneity exists in the management of community-acquired pneumonia at Canadian hospitals, the causes of which are poorly understood.
社区获得性肺炎是一种常见疾病，经济负担沉重。我们评估了加拿大医院收治的社区获得性肺炎患者的临床实践及治疗结果。
共有20家医院（11家教学医院和9家社区医院）参与。回顾了1996年11月、1997年1月和1997年3月期间收治的成年患者病历数据，以确定住院时间（LOS）、入住重症监护病房情况及30天院内死亡率。多变量分析研究了住院时间变异性的来源。确定了抗生素治疗的类型和持续时间以及按照临床实践指南接受治疗的患者比例。
共识别出858例符合条件的患者；他们的平均年龄为69.4岁（标准差17.7）。总体中位住院时间为7.0天（四分位间距[IQR]4.0 - 11.0天）；各医院的中位住院时间为5.0至9.0天（IQR 6.0 - 7.8天）。住院时间变异性中只有22%可由已知因素解释（疾病严重程度占12%；存在慢性阻塞性肺疾病或肺炎的细菌病因占2%；医院类型占7%）。总体30天死亡率为14.1%（95%置信区间[CI]11.8% - 16.6%）；13.6%的患者入住重症监护病房（95% CI 11.4% - 16.1%）。静脉抗生素治疗的中位持续时间为5天（各医院范围3.0 - 6.5天）。虽然79.8%的患者按照临床实践指南接受治疗，但各医院对指南的依从率在47.9%至100%之间。
加拿大医院在社区获得性肺炎的管理方面存在相当大的异质性，其原因尚不清楚。
