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Usefulness of a predictive model to hospitalize patients with low-risk community-acquired pneumonia

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Introduction

A high proportion of patients with low-risk community-acquired pneumonia (CAP) (classes I-III of the Pneumonia Severity Index) are hospitalized. The purpose of this study was to determine whether validated severity scales are used in clinical practice to make admission decisions, identify the variables that influence this decision, and evaluate the potential predictive value of these variables.

Materials and methods

A prospective, observational study of patients ≥ 18 years of age with a diagnosis of low-risk CAP hospitalized or referred from the Emergency Department to outpatient consultations. A multivariate logistic regression predictive model was built to predict the decision to hospitalize a patient.

Results

The study population was composed of 1,208 patients (806 inpatients and 402 outpatients). The severity of CAP was estimated in 250 patients (20.7%). The factors that determined hospitalization were “abnormal findings in complementary studies” (643/806: 79.8%; due to respiratory failure in 443 patients) and “signs of clinical deterioration” [64/806 (7.9%): hypotension (16/64, 25%); hemoptoic expectoration (12/64, 18.8%); tachypnea (10/64, 15.6%)]. In total, ambulatory management was not contraindicated in 24.7% of hospitalized patients (199). The predictive model built to decide about hospitalization had a good power of discrimination (AUC 0.876; 95%CI: 0.855–0.897).

Conclusions

Scales are rarely used to estimate the severity of CAP at the emergency department. The decision to hospitalize or not a patient largely depends on the clinical experience of the physician. Our predictive model showed a good power to discriminate the patients who required hospitalization. Further studies are warranted to validate these results.

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Data availability

Data available on request fro the authors.

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Authors and Affiliations

  1. Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Travesía da Choupana S/N, 15706, Santiago de Compostela, Spain

    Adriana Lama, María Elena Toubes, Ana Casal, Jorge Ricoy, Carlos Rábade, Nuria Rodríguez-Núñez, Uxío Calvo & Luis Valdés

  2. Concepción Arenal Primary Care Centre Grupo de Métodos de Investigación, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Unidad de Epidemiología Clínica Complejo Hospitalario Clínico-Universitario de Santiago, Santiago de Compostela, Spain

    Francisco Gude & Ana Cao-Ríos

  3. Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, Spain

    Luis Valdés

  4. Departamento de Medicina, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain

    Luis Valdés

Authors
  1. Adriana Lama
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Contributions

Adriana Lama Author and drafting, Conception and design, Approval of the final manuscript, Francisco Gude Author and drafting, Conception and design, Approval of the final manuscript, María Elena Toubes Co-author, Approval of the final manuscript, Ana Casal Co-author, Approval of the final manuscript, Jorge Ricoy Co-author, Approval of the final manuscript, Carlos Rábade. Co-author. Approval of the final manuscript, Nuria Rodríguez Núñez Co-author, Approval of the final manuscript, Ana Cao-Ríos Co-author, Approval of the final manuscript, Uxío Calvo Co-autor, Approval of the final manuscript, Luis Valdés Author and drafting, Conception and design, Approval of the final manuscript.

Corresponding author

Correspondence to Ana Casal.

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Lama, A., Gude, F., Toubes, M.E. et al. Usefulness of a predictive model to hospitalize patients with low-risk community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 43, 61–71 (2024). https://doi.org/10.1007/s10096-023-04683-w

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