Home Care NetWork
Home Care Literature Reviews 2003
Pneumonia:
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377-82.
This British analysis of data from 1068 patients (mean age 64 years, 51.5% male, 30 day mortality 9%) from three prospective studies of community acquired pneumonia (CAP) developed a prediction rule for 30 day mortality that involved a six point score, one point for each of Confusion, Urea >7 mmol/l, Respiratory rate >= 30/min, low systolic(<90 mm Hg) or diastolic (<=60 mm Hg) blood pressure, age >=65 years and enabled patients to be stratified according to increasing risk of mortality: score 0, 0.7%; score 1, 3.2%; score 2, 3%; score 3, 17%; score 4, 41.5% and score 5, 57%. This is an easy and useful approach to assessing the risk of treating patients with CAP at home.
Fernandez-Sabe N, Carratala J, Roson B, Dorca J, Verdaguer R, Manresa F, Gudiol F. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine (Baltimore). 2003;82:159-69.
This Spanish case series of 1,474 adult patients who were hospitalized for community-acquired pneumonia (CAP); 1,169 patients age ≤ 80 years and 305 (21%) patients aged > 80 years ("very elderly") found that the most common causative organism was Streptococcus pneumoniae (23% in both groups). Aspiration pneumonia was more frequent in the very elderly (5% in younger patients versus 10% in the very elderly); Legionella pneumophila (8% in younger patients versus 1% in the very elderly) and atypical agents (7% in younger patients versus 1% in the very elderly) were rarely recorded in the very elderly. The development of in hospital complications (26% in younger versus 32% in very elderly patients) as well as early mortality (2% in younger versus 7% in very elderly patients) and overall mortality (6% in younger versus 15% very elderly patients) were significantly higher in very elderly patients. Acute respiratory failure and shock/multiorgan failure were the most frequent causes of death, especially of early mortality. Factors independently associated with 30-day mortality in the very elderly were altered mental status on admission (odds ratio, 3.69), shock (odds ratio, 10.69), respiratory failure (odds ratio, 3.50), renal insufficiency (odds ratio, 5.83), and Gram-negative pneumonia (odds ratio, 20.27). An exhaustive and insightful article that gives an excellent overview of the challenge of CAP in the very old.
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