STUDY OBJECTIVES: (1) To define clinical factors that could justify hospital admission among @entity1 with @entity497 ( @entity497 ) with risk classes of I or II. (2) To determine the positive predictive value of the @entity55 severity index as the sole indicator for detecting inappropriate hospitalizations among @entity1 with @entity497 . DESIGN: Retrospective observational study. SETTING: University of Louisville Hospital and the Veterans Affairs Medical Center of Louisville, KY. @entity1 : Consecutive adult @entity1 fulfilling the criteria for @entity497 who were admitted to the hospital between October 1997 and May 2000. MEASUREMENTS AND RESULTS: The medical records of hospitalized @entity1 with @entity497 having a risk class of I or II were identified and further reviewed to determine whether there existed a clinical basis to justify hospitalization. Of a total of 328 @entity1 , 86 had a risk class of I or II. Among these, 72 had clinical factors that justified their hospital admission. These factors, in frequency of occurrence, included the following: medical conditions other than @entity497 that required hospitalization, 31 @entity1 (43%); social needs, 13 @entity1 (18%); oral intolerance, 10 @entity1 (14%); failure of outpatient therapy, 10 @entity1 (14%); noncompliance, 6 @entity1 (9%); suspicion of @entity295 , 1 @entity1 (1%); and @entity519 , 1 @entity1 (1%). Among the 86 @entity1 with low risk classes (ie, classes I or II), 14 were found to be inappropriately hospitalized, yielding a positive predictive value of 16%. CONCLUSIONS: The @entity55 severity index, used as the sole indicator for detecting inappropriate hospitalizations, has an unacceptably low positive predictive value. This is due primarily to the severity of comorbid conditions requiring in-hospital care in @entity1 with a nonsevere @entity55 . According to our study, the @entity55 severity index should not be used as the sole indicator with which to define inappropriate hospitalization.

Hospitalization for @entity497 : the XXXX severity index vs clinical judgment.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'PATIENTS'] @entity295 :: ('MESH:D018805', 'Disease') :: ['sepsis'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity519 :: ('MESH:D000860', 'Disease') :: ['hypoxemia'] @entity497 :: ('MESH:D003147', 'Disease') :: ['CAP', 'community-acquired pneumonia']
@entity55 :: (MESH:D011014,Disease) :: ['pneumonia']
