Rhew D C, Hackner D, Henderson L, Ellrodt A G, Weingarten S R
Department of Health Services Research, Cedars-Sinai Health System and UCLA School of Medicine, Los Angeles, USA.
Chest. 1998 Jan;113(1):142-6. doi: 10.1378/chest.113.1.142.
To assess the benefit of in-hospital observation in "low-risk" patients with community-acquired pneumonia.
Retrospective review of data from a prospective study.
Teaching community hospital.
We studied 717 consecutive, adult patients admitted to the hospital for pneumonia.
One hundred forty-five patients were classified at low-risk for complications using previously studied criteria; 144 (99%) charts were available for review. Two patients had "obvious reasons for continued hospitalization" on the day of antibiotic conversion and were excluded. One hundred two patients were observed, and 40 were not observed in-hospital after switch to oral antibiotics. No patient from either group required medical intervention within 24 h after hospital discharge. Five "observed" patients (5%, 95% confidence interval [CI], 2 to 11%) returned to the emergency department, three (3%; 95% CI, 0 to 9%) with respiratory complaints. Two (2%; 95% CI, 0 to 7%) "observed" patients were admitted to the hospital with recurrent pneumonia. One (3%; 95% CI, 0 to 13%) "not observed" patient returned to the emergency department with a nonrespiratory complaint and was not admitted. No patient from either group died within 30-day clinical follow-up. The length of stay for the "observed" and "not observed" groups was 98+/-33 h and 83+/-49 h, respectively. The difference in length of stay was 15 h (95% CI, 3 to 27).
In-hospital observation for low-risk patients admitted with community-acquired pneumonia after switch from parenteral to oral antibiotics is of limited benefit, and elimination of this practice could potentially reduce length of stay by almost 1 day per patient. This could translate into a cost savings of $57,200 for the 22-month study period. These results require prospective validation in a larger study.
评估对社区获得性肺炎“低风险”患者进行住院观察的益处。
对一项前瞻性研究的数据进行回顾性分析。
教学社区医院。
我们研究了717例因肺炎连续入院的成年患者。
根据先前研究的标准，145例患者被归类为并发症低风险；144例（99%）病历可供审查。2例患者在抗生素转换当天有“继续住院的明显理由”，被排除。102例患者接受了观察，40例在改用口服抗生素后未进行住院观察。两组患者在出院后24小时内均无需医疗干预。5例“接受观察”的患者（5%，95%置信区间[CI]，2%至11%）返回急诊科，3例（3%；95%CI，0%至9%）有呼吸道症状。2例（2%；95%CI，0%至7%）“接受观察”的患者因复发性肺炎再次入院。1例（3%；95%CI，0%至13%）“未接受观察”的患者因非呼吸道症状返回急诊科，未被收治。两组患者在30天临床随访内均无死亡。“接受观察”组和“未接受观察”组的住院时间分别为98±33小时和83±49小时。住院时间差异为15小时（95%CI，3至27）。
对于社区获得性肺炎低风险患者，在从静脉抗生素转换为口服抗生素后进行住院观察的益处有限，取消这种做法可能使每位患者的住院时间潜在缩短近1天。这可能在22个月的研究期间节省57,200美元的成本。这些结果需要在更大规模的研究中进行前瞻性验证。
