PURPOSE: Community acquired pneumonia (CAP), a common but potentially serious disease, is an important cause of hospital admission. However, most CAP patients are admitted just based on doctors’ clinical judgments, rather than CURB-65, a well known tool for assessing CAP severity. The present study aims to retrospective analysis the correlation of admissions decisions based on doctors’ clinical judgment with CURB-65 score for CAP patients.
METHODS: A retrospective analysis information of CAP patients admitted in general respiratory ward just by doctors’ clinical judgment was conducted in a general hospital from 2008 to 2010. A CURB-65 score was applied to all CAP patients, and admission decisions were compared.
RESULTS: A total of 1436 hospitalized CAP patients from emergency or outpatient department were included, all were confirmed by chest radiographs and compatible clinical outcomes. There were 873 males and 563 females with age ranged from 16 to 97 years. All patients were re-assessed pneumonia severity with CURB-65 score using the data from the patient record. According to the score recommendation, majority of these patients (1242 cases, 86.49%, score≥2) needed inpatient care, which means that most of the admission decisions made by the doctors with clinical judgment were appropriate. However, 194 cases of mild CAP patients without comorbidities were also admitted in spite of CURB-65 score suggestion for outpatient management, further data analysis demonstrated that 86.59% of these admission decisions were made by junior doctors.
CONCLUSIONS: Senior doctors could make the appropriate admission decisions for most CAP patients regardless of the CURB-65 score, while routine use of CURB-65 score will be helpful for junior doctors identify mild CAP patients thus potentially reducing unnecessary admissions.
CLINICAL IMPLICATIONS: CURB-65 score is a useful tool to identify which group of CAP patients need inpatient treatment, especially for junior doctors, which will be helpful to reduce unnecessary admissions and save medical resources.
DISCLOSURE: The following authors have nothing to disclose: Shen Yongchun, Wen Fuqiang, Wan Chun
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