Infectious disease: #83 Low-risk community acquired pneumonia: Sociodemographic and clinical determinants for hospitalization

PURPOSE: To elucidate socio-demographic and clinical determinants for hospitalization among “low-risk” community acquired pneumonia (CAP) patients. “Low-risk” patients are HIV negative, non-nursing home residents with no major renal, neoplastic or hepatic diseases, and with a Pneumonia Severity Index (PSI) less than 90. METHODS: A retrospective analysis was conducted of 296 low-risk community acquired pneumonia patients examined from January 1999 to January 2000. All patients were assigned a PSI score. 208 (70%) of patients were discharged from the emergency room while 80 (30%) were hospitalized. All patients were assigned to classes I-V according to PSI score. A comparison was made between PSI class II patients discharged from the emergency department and those hospitalized. RESULTS: Predictors for hospitalization were female gender (p < 0.01), African American race (p < 0.05), having medical insurance coverage (p < 0.001), elevated temperature (p < 0.001), and tachycardia (p < 0.001). No statistically significant differences were observed for altered mental status, hypotension, tachypnea, laboratory, and radiologic parameters, and social indicators (e.g., substance abuse). CONCLUSION: Socio-demographic parameters, including age, gender and insurance coverage, are important determinants for hospitalization among “low-risk” patients with community-acquired pneumonia. Clinical predictors for hospitalization were high fever, and tachycardia. The average length of stay for in-patient care was 3.5 days (Range = 3 to 5 days), at ten times higher the cost of out-patient care. This study supports the recommendation of using the PSI for ED evaluation of patients.