Evaluación de un modelo multidisciplinar de hospitalización alternativa a la hospitalización convencional en la neumonía adquirida en la comunidad / Evaluation of a multidisciplinar y alternative hospitalization model in comparison with conventional hospitalization for patients with community-acquired pneumonia

Objetivo: Evaluar la estancia hospitalaria y la mortalidad de un modelo multidisciplinar de hospitalización alternativa (HA) frente a un sistema de hospitalización convencional(HC) en pacientes con neumonía adquirida en la comunidad (NAC). Método: Estudio observacional prospectivo, en el que se incluyó a todos los pacientes con NAC atendidos en el servicio de urgencias (SU) de un hospital general durante un año. Se recogieron las variables sociodemográficas, de comorbilidad, clínicas y de laboratorio. Se calcularon el Pneumonia Severity Index (PSI) y el índice de Barthel en el momento del ingreso. A su ingreso se asignaron de forma no aleatoria a un modelo de HC o al modelo de HA, consistente en ingreso en la unidad de corta estancia de urgencias y alta con seguimiento en el hospital de día de la unidad de enfermedades infecciosas o seguimiento a través de la unidad de hospitalización a domicilio. Se evaluó la estancia hospitalaria y la mortalidad a los 30 días. Resultados: Ingresaron 425 (77,2%) pacientes, 130 en HA y 252 en HC. Los asignados a HA eran de mayor edad (69 frente a 62,7 años; p < 0,001), con mayor deterioro funcional (47 % frente a 23,8 %; p < 0,001), con mayor puntuación PSI (PSI IV 61,5 %frente al 36,9 %; p < 0,001), con menor estancia media hospitalaria (2,5 frente a 9,6días; p < 0,001) y menor mortalidad a los 30 días (3,9 % frente a 11,2 %; p < 0,05,riesgo relativo 0,3, intervalo de confianza del 95% 0,1-0,8). Conclusiones: Un modelo multidisciplinar de HA alternativo de hospitalización en el manejo de la NAC permite reducir la estancia hospitalaria y la mortalidad asociada (AU)

Objective: To compare duration of hospital stay and mortality between conventional hospitalization and an alternative hospital care model for patients with community-acquired pneumonia (CAP).Patients and methods: Prospective, non randomized study including all patients with CAP treated in our hospital’semergency department (ED) in 1 year. We recorded information on sociodemographic variables, comorbidity, clinical condition, and laboratory findings. The Pneumonia Severity Index (PSI) and the Barthel score were also recorded onadmission to the ED. A care model (alternative or conventional hospitalization) was assigned without randamization on admission. The alternative model consisted of admission to a short-stay unit in the ED, and follow-up on discharge in the day hospital of the infectious diseases department or at home by the home hospitalization staff. Outcome measures were duration of hospital stay and 30-day mortality. Results: Of a total of 550 patients, 425 (77.2%) were admitted; 252 received conventional hospital care and 130 were treated under the alternative model. Those assigned to the alternative model were older (mean age of 69 years vs. 62.7years, P<.001), had greater functional deficits (47% vs 23.8%; P<.001), and a higher PSI (PSI of IV or higher, 61.5% vs36.9%; P<.001). The duration of hospital stay was shorter under the alternative model (2.5 days vs 9.6 days, P<.001) and 30-day mortality was lower (3.9% vs 11.2%, P<.05; relative risk, 0.3 [95% confidence interval, 0.1-0.8]). Conclusions: This alternative model of hospital care for the management of CAP allows hospital stay to be shortened and it is associated with lower mortality (AU)

Epidemiologic study of community-acquired pneumonia treated at a tertiary-care hospital: Does Fine’s pneumonia severity index influence decision-making in the emergency department?

Objectives: To determine the incidence of community-acquired pneumonia and describe its characteristics. To assess differences influenced by Fine’s pneumonia severity index. Methods: Prospective, descriptive study of patients with community-acquired pneumonia treated over a period of1 year in the emergency department of Hospital General Universitario in Alicante, Spain. Social, demographic and clinical variables (including laboratory, radiologic, and microbiologic data) were collected. Destination on discharge from the emergency department and patient status at 30 days were recorded. The pneumonia severity index was determined according to Fine’s prediction rule, and patients were then classified as being at low (< III) or high (> III) risk. Differences between the 2 risk classes and the distribution of admissions according to risk were analyzed. Results: Five hundred fifty patients with community-acquired pneumonia were included. The cumulative incidence was2.2 cases per 1000 patient-years. Patients with community-acquired pneumonia at high risk had more comorbidity and functional decline, a higher incidence of respiratory failure, and infiltrates in multiple lobes. An etiologic diagnosis was established for 209 patients (38%). The most common microorganism isolated was Streptococcus pneumoniae in all risk classes. The admission rate was 77.2% (high-risk classes, 99.5%; low-risk, 65.1%). The patients were admitted to the respiratory medicine department, the short-stay unit, and the internal medicine department. Risk class influenced patient destination on discharge from the emergency department (AU)

Objetivo: Conocer la incidencia y características clínicas de los pacientes con neumonía adquirida en la comunidad (NAC) y reflejar las diferencias en función de la gravedad determinada por el índice de Fine (IF).Método: Estudio descriptivo y prospectivo de los pacientes con NAC atendidos en el servicio urgencias (SU) del Hospital General Universitario de Alicante durante un año. Se recogieron variables sociodemográficas, clínicas, analíticas, radiológicas, microbiológicas y relacionadas con el destino al alta. Se realizó seguimiento a los 30 días. Se determinó la gravedad de la NAC según el IF, y se clasificó en NAC de bajo riesgo (..) (AU)