Discordance of physician clinical judgment vs . pneumonia severity index (PSI) score to admit patients with low risk community-acquired pneumonia: a prospective multicenter study

• Published in: Journal of thoracic disease 2017-06, Vol.9 (6), p.1538-1546
• Main Authors: Marcos, Pedro J, Restrepo, Marcos I, González-Barcala, Francisco J, Soni, Nilam J, Vidal, Iria, Sanjuàn, Pilar, Llinares, Diego, Ferreira-Gonzalez, Lucía, Rábade, Carlos, Otero-González, Isabel, Marcos, Pedro, Verea-Hernando, Héctor
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd.2017.05.44

The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P