Modified Triage Method by Pneumonia Severity Index for Patients with Community: acquired pneumonia

PURPOSE: Considerable variation exists in hospital admission rates for patients with community-acquired pneumonia (CAP). The objective of this study was to evaluate whether the pneumonia severity index (PSI) could be applied to patients with CAP as a method for triage in an emergency medical center. METHODS: A total number of 110 patients admitted with community-acquired pneumonia between January 1997 and September 2001. Their medical records were reviewed, with pneumonia severity index, and other risk factors, the time to resolution, and the results of treatment being evaluated. RESULTS: The pneumonia severity index accurately identified the patients with community-acquired pneumonia. Factors we evaluated were related to significant differences statistically, including such as PaCO2, WBC count, suffered lobe count, hypoxic index (PaO2/ F i O2), diabetes, hypertension, number of coexisting illness, period of admission and intravenous antibiotic therapy, and aggravated PaO2. If body temperature was less than 38.5 degrees C, it was considerable for outpatients clinics in Class I and II. CONCLUSION: The pneumonia severity index was a useful screening tool for patients with community-acquired pneumonia. Admission and an active therapeutic plan could be recommended for patients assigned to Class III. Inappropriate admissions were reduced to 27.3% by modified triage algorithm.

Duration-Dependent Neuroprotective Effect of Post-Ischemic Mild Hypothermia in the Gerbil Global Ischemic-Reperfusion Model

BACKGROUND: The present study was performed in order to evaluate the duration-dependent neuroprotective effect of post-ischemic mild hypothermia against delayed neuronal damage following transient global ischemia and to estimate the optimal duration of brief post-ischemic mild hypothermia. METHODS: Post-ischemic mild hypothermia of different duration(1 hour, 3 hours, and 6 hours) was performed immediately after 10-minute global ischemia in gerbils, and the hippocampal CA1 cell loss after 3 days was evaluated. The duration-dependent neuroprotective effect of post-ischemic mild(33-34degrees C) hypothermia of each duration was compared to the normothermic control by using histopathological methods. RESULTS: 1, 3 and 6 hours of mild hypothermia immediately following reperfusion resulted in progressively increased protection from ischemic damage, 10.0+/-8.2%, 33.7+/-21.9%, and 75.9+/-13.4%, respectively. The 3-hour and the 6-hour post-ischemic mild hypothermia groups revealed significant decreases in hippocampal CA1 area cell loss compared to the normothermic control group(9.0+/-7.7%, p<0.05), and the 6-hour group had a greater preservation than the 3-hour group(p<0.05). CONCLUSION: The results suggest that post-ischemic mild hypothermia protects against delayed neuronal damage in the hippocampal CA1 area following 10-minute transient global ischemia: 3-hour post-ischemic mild hypothermia provides a potential reduction of neuronal damage, but a 6-hour treatment is more effective in preventing neuronal damage than a 3-hour one.