PURPOSE: Studies have suggested that early antibiotic administration is associated with improved survival in community acquired pneumonia (CAP). We analyzed an emergency department (ED) triage program designed to improve early CAP detection and timely administration of antibiotics.
METHODS: We reviewed all patients who screened positively over a 3 month period (July to October, 2007) in an ED point of triage program designed to identify potential CAP patients, based on presenting clinical complaints and signs.
RESULTS: A total of 482 patients were assessed to have possible CAP. The mean time from triage to CXR was 167 minutes, with 30.91 % having CXRay in < 1 hr. Of all patients triaged as possible CAP, 71.1% required hospitalization, but only 15.14% of all patients had definite radiographic pneumonia and 26.35% had possible radiographic pneumonia. Of the 150 patients with an ED diagnosis of pneumonia, 89.33 % were admitted and 48 % had definite radiographic pneumonia, 33.33 % had possible radiographic pneumonia. A total of 52.1 % of all triaged patients received antibiotic therapy for respiratory tract infection. The mean time to administer antibiotics for pneumonia patients was 192 minutes vs 217 minutes for the entire group. 75.33% of patients with an ED diagnosis of CAP still had this diagnosis on discharge. Of the patients with ED diagnosis of pneumonia, that was not present on discharge, 93.33% had received antibiotics, which were administered at a mean of 171 min. The positive predictive value of the triage program for a final hospital discharge diagnosis of pneumonia was 23.4 %.
CONCLUSION: The intense triage program led to rapid administration of antibiotics but patients with and without CAP received antibiotics equally rapidly. The PPV of the program was low for identifying patients who had a discharge diagnosis of CAP.
CLINICAL IMPLICATIONS: While a triage program can lead to rapid antibiotic administration in patients with signs and symptoms suggesting CAP, our criteria were too broad to assure that rapid administration of antibiotics was limited to only CAP patients.
DISCLOSURE: Navdeep Brar, No Financial Disclosure Information; No Product/Research Disclosure Information