The clinical benefit of in-hospital observation in 'low-risk' pneumonia patients after conversion from parenteral to oral antimicrobial therapy

Chest
D C RhewS R Weingarten

Abstract

To assess the benefit of in-hospital observation in "low-risk" patients with community-acquired pneumonia. Retrospective review of data from a prospective study. Teaching community hospital. We studied 717 consecutive, adult patients admitted to the hospital for pneumonia. One hundred forty-five patients were classified at low-risk for complications using previously studied criteria; 144 (99%) charts were available for review. Two patients had "obvious reasons for continued hospitalization" on the day of antibiotic conversion and were excluded. One hundred two patients were observed, and 40 were not observed in-hospital after switch to oral antibiotics. No patient from either group required medical intervention within 24 h after hospital discharge. Five "observed" patients (5%, 95% confidence interval [CI], 2 to 11%) returned to the emergency department, three (3%; 95% CI, 0 to 9%) with respiratory complaints. Two (2%; 95% CI, 0 to 7%) "observed" patients were admitted to the hospital with recurrent pneumonia. One (3%; 95% CI, 0 to 13%) "not observed" patient returned to the emergency department with a nonrespiratory complaint and was not admitted. No patient from either group died within 30-day clinical follow-up. The length o...Continue Reading

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