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Multicenter Study
. 2009 Dec;64(12):1062-9.
doi: 10.1136/thx.2008.109785. Epub 2009 May 18.

New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality

Affiliations
Multicenter Study

New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality

S Ewig et al. Thorax. 2009 Dec.

Abstract

Background: The database of the German programme for quality in healthcare including data of every hospitalised patient with community-acquired pneumonia (CAP) during a 2-year period (n = 388 406 patients in 2005 and 2006) was analysed.

Methods: End points of the analysis were: (1) incidence; (2) outcome; (3) performance of the CRB-65 (C, mental confusion; R, respiratory rate >or=30/min; B, systolic blood pressure <90 mm Hg or diastolic blood pressure <or=60 mm Hg; 65, age >or=65 years) score in predicting death; and (4) lack of ventilatory support as a possible indicator of treatment restrictions. The CRB-65 score was calculated, resulting in three risk classes (RCs).

Results: The incidence of hospitalised CAP was 2.75 and 2.96 per 1000 inhabitants/year in 2005 and 2006, respectively, higher for males (3.21 vs 2.52), and strongly age related, with an incidence of 7.65 per 1000 inhabitants/year in patients aged >or=60 years over 2 years. Mortality (13.72% and 14.44%) was higher than reported in previous studies. The CRB-65 RCs accurately predicted death in a three-class pattern (mortality 2.40% in CRB-65 RC 1, 13.43% in CRB-65 RC 2 and 34.39% in CRB-65 RC 3). The first days after admission were consistently associated with the highest risk of death throughout all risk classes. Only a minority of patients who died had received mechanical ventilation during hospitalisation (15.74%).

Conclusions: Hospitalised CAP basically is a condition of the elderly associated with a higher mortality than previously reported. It bears a considerable risk of early mortality, even in low risk patients. CRB-65 is a simple and powerful tool for the assessment of CAP severity. Hospitalised CAP is a frequent terminal event in chronic debilitated patients, and a limitation of treatment escalation is frequently applied.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Distribution of the incidence of hospitalised community-acquired pneumonia per 1000 inhabitants and year according to age classes. Incidences in 2005, 2006 and both are shown. The indicated incidence numbers refer to the mean incidence of an age class.
Figure 2
Figure 2
Distribution of incidence of hospitalised community-acquired pneumonia per 1000 inhabitants and year according to age classes. Incidences for sex (overall 2005 and 2006) compared with overall incidence are given. The indicated incidence numbers refer to the mean incidence of an age class.
Figure 3
Figure 3
Age and sex distribution of patients hospitalised with community-acquired pneumonia (total population in 2005 and 2006).
Figure 4
Figure 4
Distribution of in-hospital death proportions of patients hospitalised with community-acquired pneumonia according to age classes (total population in 2005 and 2006).
Figure 5
Figure 5
(A) Crude number of deaths during hospitalisation, stratified for CRB-65 (C, mental confusion; R, respiratory rate ⩾30/min; B, systolic blood pressure <90 mm Hg or diastolic blood pressure ⩽60 mm Hg; 65, age ⩾65 years) scores. Data refer to the whole population in 2005 and 2006. Day 0 was not calculated because it is not a complete day. (B) Cumulative proportion of deaths, stratified for CRB-65 scores. Note that the highest mortality is observed during the first days in all risk classes, even in the lowest (CRB-65 = 0). Day 0 was not calculated because it is not a complete day.

Comment in

  • Meeting the old man's friend.
    Torres A, Menéndez R. Torres A, et al. Thorax. 2009 Dec;64(12):1016-7. doi: 10.1136/thx.2009.118299. Thorax. 2009. PMID: 19952230 No abstract available.
  • Predicting CAP-related mortality with CRB-65.
    Charles PG. Charles PG. Thorax. 2011 Mar;66(3):262; author reply 262-3. doi: 10.1136/thx.2009.133884. Epub 2010 Oct 14. Thorax. 2011. PMID: 20947893 No abstract available.

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