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J Korean Med Assoc > Volume 50(10); 2007 > Article
Lee: Patient Stratification and Decision to Hospitalize Patients with Community-Acquired Pneumonia

Abstract

Patients with community-acquired pneumonia can be divided into four groups, each with a list of likely pathogens and suggested empiric therapy accordingly. Patient classification is based on the assessment of place of therapy, the presence of cardiopulmonary disease, and the presence of modifying factors. The admission decision remains to be difficult and follows the prognostic scoring rules (the Pneumonia Patients Outcome Research Team, PORT) are widely using as admission criteria. Still clinicians use inconsistent admission criteria and often overestimate patients risk. In general, hospitalization is needed if patients have multiple risk factors for a complicated course. Admission to the intensive care unit is needed for patients with severe community-acquired pneumonia.

References

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Figure 1
Prediction rule to identify patients with community-acquired pneumonia.
jkma-50-868-g001-l.jpg
Figure 2
Severity assessment in a hospital setting: the CURB-65 score. One step strategy for stratifying patients with community-acquired pneumonia risk groups according to risk of mortality at 30 days when the results of blood urea are available.
jkma-50-868-g002-l.jpg
Table 1
Four patients groups according to American Thoracic Society community-acquired pneumonia guidelines
jkma-50-868-i001-l.jpg
Table 2
Group I: outpatients, no cardiopulmonary disease, no modifying factors *, †
jkma-50-868-i002-l.jpg

*Excludes patients at risk for HIV

In roughly 50~90% of the cases no etiology was identified

Table 3
Group II: outpatients, with cardiopulmonary disease, and/or other modifying factors *, †
jkma-50-868-i003-l.jpg

*Excludes patients at risk for HIV

In roughly 50~90% of the cases no etiology was identified

Table 4
Group III: inpatients, not in intensive care unit *, †
jkma-50-868-i004-l.jpg

*Excludes patients at risk for HIV

In roughly one-third to one-half of the cases no etiology was identified

Table 5
Group IV: intensive care unit-admitted patients *, †
jkma-50-868-i005-l.jpg

*Excludes patients at risk for HIV

In roughly one-third to one-half of the cases no etiology was identified

Table 6
Risk factors to hospitalize patients with community-acquired pneumonia
jkma-50-868-i006-l.jpg

*Predict mortality in the PORT prediction rule model

Table 7
Pneumonia Patients Outcomes Research Team(PORT) Pneumonia Severity Index (PSI)
jkma-50-868-i007-l.jpg

*Or an oxygen saturation of < 90 percent on pulse oximetry

Table 8
Class and mortality according to Pneumonia Severity Index
jkma-50-868-i008-l.jpg
Table 9
Definition of severe community-acquired pneumonia
jkma-50-868-i009-l.jpg


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