Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study

Article Abstract:

The factors that predict the prognosis, or expected outcome, of patients with pneumonia were assessed. Such predictive factors may help to identify patients who can be treated on an outpatient basis and do not need hospitalization. The study included 280 ambulatory (outpatient) and hospitalized adults with pneumonia. The patients were assessed for the development of complications and death over a six-week period. Physicians were surveyed to evaluate their reasons for treating patients in a hospital versus ambulatory setting, and treatments requiring hospitalization were identified. The criteria for hospital admission included abnormalities in vital signs, changes in mental status, complications associated with pus formation, abnormally low blood oxygen levels, abnormalities in laboratory findings, and coexisting medical problems. At initial assessment, 170 patients (61 percent of the 280) did not have a condition requiring hospital admission. However, 38 percent of these patients developed complications, and some were hospitalized. The results showed that complications of pneumonia were more likely to develop in patients older than 65 years or those with: coexisting illness; fever over 101 degrees Fahrenheit; decreased activity of the immune system; or high-risk causes of the pneumonia. An increase in the number of these risk factors was associated with a rise in the risk of complications of pneumonia. The clinical appearance of a patient was the most important factor influencing the physician's decision to hospitalize, and the use of intravenous antibiotics or chest physical therapy required admission to the hospital. These findings may help to improve the physician's ability to assess the prognosis of patients with pneumonia, and to identify low-risk patients who can be effectively treated without hospitalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Causes of, Prognosis, Hospitalization, Pneumonia

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Resting electrocardiograms as baseline tests: impact on the management of elderly patients

Article Abstract:

Although performing resting electrocardiograms (ECGs) has been denounced as unnecessary by some experts, many physicians continue to order them. The use of baseline ECGs in elderly patients with a variety of medical problems was evaluated in this study of residents of a retirement community in California. Baseline ECGs were obtained on each resident annually on his or her birthday. When a resident visited the emergency department (ED) and had an ECG taken, hospital house staff (physicians in training) indicated their management decisions by answering certain questions in writing. They were then shown the patient's baseline (last-birthday) ECG and asked to answer the same questions regarding treatment. Staff were then questioned concerning the value of the baseline ECG. Results showed that 47 residents (average age, 85 years) visited the ED a total of 58 times during the study period. House staff's diagnostic impressions were changed in 13 cases (22 percent), and their treatment plans were changed in 8 cases (14 percent) as a result of comparing baseline and ED ECGs. In all cases where treatment plans were changed, patients had histories of cardiovascular disease. Treatment changes were made because of findings on the baseline ECGs; in two cases, physicians decided to withhold treatment because the patients' conditions were chronic. In 53 of 58 ED visits (79 percent), staff found the baseline ECG reassuring. Faculty who participated in the study as judges were less likely than house staff to be influenced by the baseline ECGs. Further research is needed to determine the value of baseline ECGs for patients without known cardiovascular disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Diseases, Electrocardiogram, Electrocardiography

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Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study

Article Abstract:

Atrial fibrillation is an abnormal heart rhythm characterized by very rapid and incomplete contractions of the atria, the upper chambers of the heart. This results in fine, rapid, abnormal, and uncoordinated movements of the atria. Patients with atrial fibrillation have an increased risk of developing stroke. Warfarin is a drug that prevents coagulation of the blood and is effective in preventing stroke in patients with atrial fibrillation that is nonrheumatic (unrelated to rheumatic fever). However, treatment with warfarin is risky and inconvenient, and its use to prevent stroke should be limited to high-risk groups. The factors that increase the risk of stroke were assessed in 134 patients with nonrheumatic atrial fibrillation who had suffered a stroke, and in 131 patients with nonrheumatic atrial fibrillation who had not had a stroke. Stroke patients tended to be older and to have high blood pressure (hypertension) compared with subjects who had never had a stroke. The risk of stroke was increased in patients with hypertension and in patients over 75 years old; the risk of was greatest among patients who had both of these characteristics. These findings suggest that for elderly patients with nonrheumatic atrial fibrillation with a history of hypertension, long-term anticoagulant treatment to prevent stroke should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Stroke (Disease), Stroke, Anticoagulants (Medicine), Anticoagulants, Atrial fibrillation

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