Skip to main content

Optimized patient transfer using an innovative multidisciplinary assessment in the Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections

Introduction

Current medical scores have limited efficiency and safety to assign the most appropriate treatment site to patients with lower respiratory tract infections (LRTIs) [14]. We describe our current triage practice and assessed the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions.

Methods

Consecutive patients with LRTIs were prospectively followed and retrospectively classified according to CURB65 and ProADM levels (CURB65-A). Low medical risk patients were further subgrouped according to biopsychosocial and functional risks. We compared proportions of patients virtually allocated to triage sites with actual triage decisions and assessed the added impact of ProADM in a subgroup.

Results

Ninety-six percent of 253 patients were hospitalized. Among the 138 patients with available CURB65-A, 17.4% had low medical risk indicating possible treatment in an outpatient or nonacute medical setting; 34.1% had intermediate medical risk (short hospitalization); and 48.6% had high medical risk (hospitalization). Fewer patients were in a low CURB65-A class (I) than a low CURB65 class (0, 1) (17.4% vs. 44.6%, P < 0.001). Mean length of hospitalization was 9.4 days including 3.5 days after reaching medical stability. In 56.9% of patients, hospitalization was prolonged after medical stability mainly for medical reasons.

Conclusions

Current rates of hospitalization are high in patients with LRTI and the length of stay frequently extended beyond time of medical stabilization. The lower proportion of patients reclassified as low risk by adding ProADM to the CURB65 score might improve confidence in the triage algorithm.

References

  1. 1.

    Aliyu ZY, et al.: Determinants for hospitalization in 'low-risk' community acquired pneumonia. BMC Infect Dis 2003, 3: 11. 10.1186/1471-2334-3-11

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    Marrie TJ: Risks and outcomes in community acquired pneumonia. Can Respir J 1999,6(Suppl A):6A-9A.

    PubMed  Google Scholar 

  3. 3.

    Fine MJ, et al.: A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997, 336: 243-250. 10.1056/NEJM199701233360402

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Lim WS, et al.: Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003, 58: 377-382. 10.1136/thorax.58.5.377

    PubMed Central  CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to F Dusemund.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Dusemund, F., Albrich, W., Rüegger, K. et al. Optimized patient transfer using an innovative multidisciplinary assessment in the Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections. Crit Care 15, P456 (2011). https://doi.org/10.1186/cc9876

Download citation

Keywords

  • Lower Respiratory Tract Infection
  • Current Triage
  • Medical Risk
  • Medical Setting
  • Triage Site