Poster presentation | Open | Published:
Optimized patient transfer using an innovative multidisciplinary assessment in the Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections
Critical Carevolume 15, Article number: P456 (2011)
Current medical scores have limited efficiency and safety to assign the most appropriate treatment site to patients with lower respiratory tract infections (LRTIs) [1–4]. We describe our current triage practice and assessed the potential of a combination of CURB65 with proadrenomedullin (ProADM) levels for triage decisions.
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.
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.
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.
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
Marrie TJ: Risks and outcomes in community acquired pneumonia. Can Respir J 1999,6(Suppl A):6A-9A.
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
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