PURPOSE: More than one million patients with community acquired pneumonia (CAP) patients are admitted per year at an estimated cost of 23 billion dollars. Severity scores have been constructed from Pneumonia Outcomes Research Trial (PORT) and British Thoracic Society-CURB (BTS-CURB) data using age, medical comorbidities, and clinical parameters. These predictions have been used in admission decision making. These studies focused on older adults, with the average age being greater than 50. The goal of this study was to determine which parameters predict CAP severity in a young adults.
METHODS: Charts from July 2001 to July 2004 with ICD-9 codes of CAP and variations in age ranges of 17-40 were reviewed. Patients with cystic fibrosis, chronic immune suppression, and HIV/AIDS were excluded. Historical data including prior pulmonary disease and prior antibiotic use were recorded. Initial and 24 hour vital signs (VS) including SBP, DBP, Temperature, intake/outputs and SPO2 were recorded. Data including CBC, BUN, UA, microbiology data, and chest radiographic descriptions were recorded. Primary outcomes were death, length of stay (LOS), ICU admission, and ICU LOS. Secondary outcomes were need for thoracentesis, high-flow oxygen use, and CT imaging. Initial statistical modeling utilizing correlation analysis and multiple regression were performed.
RESULTS: Data analysis was performed on 192 charts. The median age was 20. Median LOS was 3.8 days, 16 patients required ICU admission with median LOS of 2.7 days, 19 CT scans were performed, 7 patients required thoracentesis, and no deaths. Previous pulmonary disease, initial vital signs, and laboratory values did not predict primary endpoints (no r value >.6, no r squared value >.5).
CONCLUSION: Clinical parameters useful in older adult patients were not useful in predicting clinical course in a young adult population. Current prediction models do not predict young adult CAP severity as defined by LOS, ICU admission, ICU LOS, need for procedures, or CT imaging.
CLINICAL IMPLICATIONS: Current tools used to evaluate young adult pneumonia severity are inadequate. Prospective investigation into other clinical and biochemical parameters should be undertaken.
DISCLOSURE: Michael Tripp, None.