Decisions about Treating Community-Acquired Pneumonia
Authors: Lionel Mandell
Journal: Annals of Internal Medicine (2005)

Editorials1 February 2005Decisions about Treating Community-Acquired PneumoniaLionel Mandell, MDLionel Mandell, MDFrom McMaster University, Hamilton, Ontario L8V 1C3, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-3-200502010-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Whether to treat a patient with community-acquired pneumonia (CAP) as an outpatient or as an inpatient is an extremely important decision, yet admission rates vary considerably (1-3). The nature of investigational tests, the types and route of administration of drugs selected for treatment, and the cost of care all differ according to the site of care. Inpatient treatment costs are often 20 to 25 times greater than outpatient costs (4, 5).An estimated 4 million cases of CAP occur annually in the United States. These cases account for at least 600 000 hospital admissions and 64 million days of restricted activity ...References1. McMahon LF, Wolfe RA, Tedeschi PJ. Variation in hospital admissions among small areas. A comparison of Maine and Michigan. Med Care. 1989;27:623-31. [PMID: 2498586] CrossrefMedlineGoogle Scholar2. Roos NP, Wennberg JE, McPherson K. Using diagnosis-related groups for studying variations in hospital admissions. Health Care Financ Rev. 1988;9:53-62. [PMID: 10312632] MedlineGoogle Scholar3. Fine MJ, Hough LJ, Medsger AR, Li YH, Ricci EM, Singer DE, et al. The hospital admission decision for patients with community-acquired pneumonia. Results from the pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 1997;157:36-44. [PMID: 8996039] CrossrefMedlineGoogle Scholar4. Lave JR, Lin CJ, Fine MJ, Hughes-Cromwick P. The cost of treating patients with community-acquired pneumonia. Seminars in Respiratory and Critical Care Medicine. 1999;20:189-97. CrossrefGoogle Scholar5. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther. 1998;20:820-37. [PMID: 9737840] CrossrefMedlineGoogle Scholar6. Dixon RE. Economic costs of respiratory tract infections in the United States. Am J Med. 1985;78:45-51. [PMID: 4014287] CrossrefMedlineGoogle Scholar7. National Center for Health Statistics. National hospital discharge survey: annual survey 1990. Vital Health Stat. 1998;13:1-225. Google Scholar8. Fine MJ, Singer DE, Marrie TJ, et al. Medical outcomes of ambulatory and hospitalized low risk patients with community acquired pneumonia. J Gen Intern Med. 1994;9:29. MedlineGoogle Scholar9. Coley CM, Li YH, Medsger AR, Marrie TJ, Fine MJ, Kapoor WN, et al. Preferences for home vs hospital care among low-risk patients with community-acquired pneumonia. Arch Intern Med. 1996;156:1565-71. [PMID: 8687265] CrossrefMedlineGoogle Scholar10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243-50. [PMID: 8995086] CrossrefMedlineGoogle Scholar11. Carratalà J, Fernández-Sabé N, Ortega L, Castellsagué X, Rosón B, Dorca J, et al. Outpatient care compared with hospitalization for community-acquired pneumonia. A randomized trial in low-risk patients. Ann Intern Med. 2005;142:165-72. LinkGoogle Scholar12. Atlas SJ, Benzer TI, Borowsky LH, Chang Y, Burnham DC, Metlay JP, et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern Med. 1998;158:1350-6. [PMID: 9645830] CrossrefMedlineGoogle Scholar13. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000;283:749-55. [PMID: 10683053] CrossrefMedlineGoogle Scholar14. Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C, et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med. 2002;166:717-23. [PMID: 12204871] CrossrefMedlineGoogle Scholar15. Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK. Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124:2148-55. [PMID: 14665494] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From McMaster University, Hamilton, Ontario L8V 1C3, Canada.Disclosures: None disclosed.Corresponding Author: Lionel Mandell, MD, HHSC, Henderson Division, 40 Wing, Room 504, McMaster University, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada; e-mail, [email protected]ca. 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Perceptions of physicians, nurses, patients and relativesComparison of Outcomes for Low-Risk Outpatients and Inpatients With PneumoniaAdverse Events in Patients With Community-Acquired Pneumonia at an Academic Tertiary Emergency Department 1 February 2005Volume 142, Issue 3Page: 215-216KeywordsInpatientsOutpatient clinicsOutpatientsPathogensPneumoniaRoutes of administrationSafetySubstance abuse ePublished: 1 February 2005 Issue Published: 1 February 2005 CopyrightCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...