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Causes of Hospital Admission in Low Risk Community-Acquired Pneumonia (CAP): A Prospective Multicenter Study FREE TO VIEW

Pedro Marcos, MD; Iria Vidal, MD; Francisco Barcala, MD; Pilar Sanjuán, MD; Carlos Rábade, MD; Diego Llinares, MD; Lucia Ferreira-Gonzalez, MD; Pedro Macos-Velázquez, MD; Hector Verea, MD
Chest. 2011;140(4_MeetingAbstracts):898A. doi:10.1378/chest.1119557
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PURPOSE: The aim of this study is to describe the characteristics of a group of low risk community-acquired pneumonia admitted to hospital and the causes of their admission.

METHODS: Prospective,multicenter study ,6 spanish hospitals. Eligible subjects had been admitted with a diagnosis of CAP between 10/10/2008 and 10/01/2010 , a confirmatory chest xRay,and a pneumonia severity index(PSI) of 1 or 2 . The investigators had to contact with the physician who decided the admission in order to know the reasons of the admission.

RESULTS: Data were abstracted on 149 patients (57% men, age : 45.4±7.29 yo). 38( 25.5%) of them had taken antibiotics before admission, the mean of treatment days was 4.32±3.5 ,the most frequent regimen was amoxicillin-clavulanate in monotherapy in 17 cases; only in 7 of 38 cases (18%) the antibiotic régimen was concordant with the guidelines ofr management of CAP in the ambulatory setting. The mean PSI score was 48.32±16.03. An etiologic diagnosis was made in 15 (10%) of the patients, 13(8.7%) . 7(4.7%) had multilobar affectation, in 20(13.4%) the afectation was bilateral and 16(10%) had pleural efussion. The hospital lengh of stay was 7.66±7.3 days, 3(2%) an 8(5.4%)were readmitted at 30 and 90 days respectively. 4(2.7%) patients need and admission at the ICU, and there were no deaths at 30 days.The most frequent cause of admission were issues related with the complementary tests in 89(59.7%) patientes, followed by physical exploration in 64(43%), socio-personal problems in 43(28.9%), comorbilities in 40 (26.8%) and suspiction of H1N1 pneumonia in 32 (21.5%).97(65.1%) of the patients had at least two of the last causes to be admitted.

CONCLUSIONS: Two thirds of the patients admitted with CAP had at least two causes to be admitted independent of the PSI score.

CLINICAL IMPLICATIONS: PSI has always to be considered as adjuncts to clinical judgment; other important markers of disease severity; and contraindications to outpatient treatment, such as social factors.

DISCLOSURE: The following authors have nothing to disclose: Pedro Marcos, Iria Vidal, Francisco Barcala, Pilar Sanjuán, Carlos Rábade, Diego Llinares, Lucia Ferreira-Gonzalez, Pedro Macos-Velázquez, Hector Verea

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