Community acquired pneumonia (CAP) is a common problem in clinical practice. Different recommendations regarding who should be admitted to the intensive care unit (ICU) are found in CAP guidelines from various professional societies. Our specific aim was to describe how clinicians decide which CAP patients to admit to the ICU.
Self-administered survey to assess physician preferences regarding admission to the ICU in patients with CAP. We generated items for this instrument by reviewing recent literature on criteria to admit CAP patients to the ICU. All items were reviewed by the Chest Infections Network Steering Committee. We asked whether the following criteria to make the admission decision: American Thoracic Society (ATS) 1993 and 2001, British Thoracic Society (BTS, CURB, CURB-65), Pneumonia severity index (PSI class IV and V), APACHE II or III and SAPS I or II. The survey was e-mailed to ACCP members (in Chest Infections and Critical Care networks) in 2004.
393 questionnaires were returned. The most common criteria used to admit patients to the ICU were ATS 2001 (50%), APACHE II or III (28%) and PSI class V (27%). Responders were aware of ICU criteria (SAPS (74%), ATS 1993 (68%), and APACHE (67%)) but did not use it in clinical practice. However, responders were not aware and did not use the CURB (77%) or the CURB-65 (72%). Academic practitioners (n=182) used more often BTS criteria (63% vs. 51%; p=0.04), PSI Class IV (69% vs. 56%; p=0.02), and SAPS to admit patients to the ICU (87% vs. 71%; p<0.01) than non-academic practitioners (n=203). No other statistical significant differences were observed between groups.
Important differences were found in academic practitioners vs. non-academic practitioners regarding the criteria used to admit patients to the ICU with CAP.
There is a need for more unified and appropriate criteria to define which patients with CAP require admission to the ICU.
Marcos Restrepo, None.