Meyer R J, Town G I, Harrè E, Koning M, Hurrell M, Beard M E, Chambers S T
Canterbury Respiratory Research Group, Christchurch School of Medicine.
N Z Med J. 1997 Sep 26;110(1052):349-52.
To audit the management of adult patients admitted with community acquired pneumonia including the standards of clinical assessment, use of modified British Thoracic Society prognostic criteria and antibiotic therapy.
A prospective, 16 week, study of consecutive patients admitted to Christchurch Hospital with community acquired pneumonia.
Ninety-six patients met the inclusion criteria. The median age was 70 years. A pathogen was identified in 28 (26%) patients. Forty two patients fulfilled the modified British Thoracic Society criteria for severe disease and all 9 deaths occurred in that subgroup. The management guidelines were followed without exception in only 15% of cases. Documentation of the prognostic criteria was often incomplete and therefore only 33% of those patients with severe disease were correctly identified. Seventy one percent of those with severe disease were treated with only one antibiotic and there was significant delay in administering the first dose in 44% of cases. A follow up chest radiograph was performed in 43 (51%) of those discharged.
There was poor compliance with the management guidelines. There was a lack of awareness of the severity criteria leading to inadequate treatment in many cases. Further educational initiatives are indicated.
审核社区获得性肺炎成年住院患者的管理情况，包括临床评估标准、改良英国胸科学会预后标准的使用及抗生素治疗。
对克赖斯特彻奇医院收治的社区获得性肺炎连续患者进行为期16周的前瞻性研究。
96例患者符合纳入标准。中位年龄为70岁。28例（26%）患者鉴定出病原体。42例患者符合改良英国胸科学会的重症标准，9例死亡均发生在该亚组。仅15%的病例完全遵循管理指南。预后标准的记录常常不完整，因此只有33%的重症患者被正确识别。71%的重症患者仅接受一种抗生素治疗，44%的病例首剂给药存在显著延迟。43例（51%）出院患者进行了随访胸部X光检查。
管理指南的依从性较差。对严重程度标准缺乏认识，导致许多病例治疗不足。需要进一步开展教育活动。
