Minogue M F, Coley C M, Fine M J, Marrie T J, Kapoor W N, Singer D E
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02115, USA.
Ann Emerg Med. 1998 Mar;31(3):376-80. doi: 10.1016/s0196-0644(98)70350-6.
To determine the incidence, causes, and outcomes of patients hospitalized within 30 days of initiating outpatient treatment for community-acquired pneumonia (CAP).
Patients were enrolled in the Pneumonia Patient Outcomes Research Team's multicenter, prospective cohort study of CAP. All hospitalizations within 30 days of study enrollment of patients initially treated as outpatients for CAP were recorded. Two physicians used a set of predetermined definitions to independently categorize the reasons for these subsequent hospitalizations. Thirty-day mortality rate and measures of resolution of pneumonia were assessed. The setting included three university teaching hospitals, a community teaching hospital, and a staff model medical practice within a health maintenance organization.
Of the 944 enrollees with CAP initially treated in the outpatient setting, 71 (7.5%) were subsequently hospitalized within 30 days. The reason for subsequent hospitalization was CAP related in 40 patients and comorbidity related in 26 patients; 5 refused an initial offer of hospitalization. Ninety percent of pneumonia-related hospitalizations occurred within 10 days of initial presentation. Patients who were subsequently hospitalized required a median of 14 days to return to usual activities compared with 6 days for those who were not hospitalized (P<.0001). Patients with a subsequent hospitalization had a higher 30-day mortality rate, 4.2% compared with .3% (P<.01).
A small proportion of patients with CAP initially treated in the outpatient setting are subsequently hospitalized. Such patients face a higher risk of delayed recovery or death. However, the vast majority of outpatients, whether subsequently hospitalized or not, had a successful resolution of their illness. Subsequent hospitalization by 10 days after initial outpatient treatment seems a reasonable screening tool for potentially unsatisfactory quality of care for patients with CAP.
确定社区获得性肺炎（CAP）门诊治疗开始后30天内住院患者的发病率、病因及转归。
患者纳入肺炎患者预后研究团队的CAP多中心前瞻性队列研究。记录研究入组时最初作为门诊治疗的CAP患者在30天内的所有住院情况。两名医生使用一组预先确定的定义对这些后续住院的原因进行独立分类。评估30天死亡率和肺炎缓解指标。研究地点包括三家大学教学医院、一家社区教学医院以及一家健康维护组织内的员工模式医疗诊所。
944例最初在门诊治疗的CAP入组患者中，71例（7.5%）随后在30天内住院。后续住院原因与CAP相关的有40例，与合并症相关的有26例；5例拒绝了最初的住院提议。90%与肺炎相关的住院发生在首次就诊后的10天内。随后住院的患者恢复正常活动的中位时间为14天，而未住院患者为6天（P<0.0001）。后续住院患者的30天死亡率更高，为4.2%，而未住院患者为0.3%（P<0.01）。
一小部分最初在门诊治疗的CAP患者随后会住院。这些患者面临恢复延迟或死亡的更高风险。然而，绝大多数门诊患者，无论随后是否住院，病情都得到了成功缓解。门诊治疗开始后10天内的后续住院似乎是筛查CAP患者潜在护理质量不佳的合理工具。
