Clinical judgment versus the Pneumonia Severity Index in making the admission decision

The Journal of Emergency Medicine
Gregory SeymannDaniel Davis

Abstract

The Pneumonia Severity Index (PSI) is a validated risk assessment tool for patients with community-acquired pneumonia (CAP). Guidelines endorse outpatient treatment for patients deemed low risk, but experience shows that such patients are frequently hospitalized. We investigated the limitations of the PSI as a triage tool by examining outcomes in patients whose disposition from the Emergency Department differed from that predicted by the PSI. PSI scores were calculated by retrospective chart review for all adults with CAP presenting to the Emergency Department of a university medical center. Disposition was classified as consistent with the PSI when low-risk patients were discharged and high-risk patients were admitted. Charts of low-risk patients whose disposition was inconsistent with the PSI were abstracted for documentation of comorbidities contributing to the admission decision, as well as length of stay and level of care. There were 174 patients with CAP who met inclusion criteria, and 32% had a disposition inconsistent with the PSI. Eighty-six percent of the inconsistencies involved low-risk patients admitted to the hospital, and 41% of all low-risk patients with CAP were hospitalized. Hypoxia contributed to the decision...Continue Reading

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Citations

Feb 5, 2013·Current Infectious Disease Reports·Stefano AlibertiFrancesco Blasi
Sep 29, 2012·Lung India : Official Organ of Indian Chest Society·Dheeraj GuptaUNKNOWN Pneumonia Guidelines Working Group
Sep 18, 2012·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·José LabarèreBeat Mueller
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Nov 2, 2011·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·M WoodheadUNKNOWN Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases
Sep 16, 2020·BMC Emergency Medicine·Maria Louise GamborgPeter Musaeus
Dec 23, 2020·Annals of Emergency Medicine·UNKNOWN American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Community-Acquired PneumoniaStephen J Wolf

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