Halm et al studied the risk of an adverse event occurring after discharge from the hospital following admission for a community-acquired pneumonia. The number of unstable factors present in the 24 hours before discharge correlated with disability, readmission and death. The authors are from 5 university hospitals in the US and Canada.
Patient evaluation: during the 24 hours prior to discharge
Inclusion and exclusion criteria:
(1) >= 18 years of age
(2) clinical and radiologic evidence of acute pneumonia
(3) not HIV-positive
(4) not previously admitted within the past 10 days
Parameters associated with clinical stability:
(1) temperature
(2) heart rate
(3) respiratory rate
(4) systolic blood pressure
(5) oxygen saturation
(6) oral intake
(7) mental status
|
Parameter |
Finding |
Points |
|
temperature |
<= 37.8° |
0 |
|
|
> 37.8°C |
1 |
|
heart rate |
<= 100 beats per minute |
0 |
|
|
> 100 breaths per minute |
1 |
|
respiratory rate |
<= 24 breaths per minute |
0 |
|
|
> 24 breaths per minute |
1 |
|
systolic blood pressure |
>= 90 mm Hg |
0 |
|
|
< 90 mm Hg |
1 |
|
oxygen saturation |
>= 90% |
0 |
|
|
< 90% |
1 |
|
ability to maintain oral intake |
able |
0 |
|
|
unable |
1 |
|
mental status |
normal |
0 |
|
|
abnormal |
1 |
number of unstable factors =
= SUM(points for all 7 parameters)
Interpretation:
• minimum number of unstable factors: 0
• maximum number of unstable factors: 7
• The greater the number of unstable factors, the greater risk of an adverse event following discharge from the hospital.
• The presence of 1 unstable factor raised the risk of an adverse event slightly (adjusted odds ratio 1.1 for death to 1.5 for disability at 30 days).
|
Adverse Event |
Adjusted Odds Ratio when >= 2 Unstable Findings Present |
p value |
|
death |
14.1 |
< 0.001 |
|
readmission |
3.5 |
0.02 |
|
unable to return to usual activities within 30 days of discharge |
1.6 |
0.007 |
from Table 3, page 1282
Performance in predicting adverse events:
• The negative predictive value was 89%, while the positive predictive value was only 17% for >= 1 factor and 46% for >= 2 factors.
• Specificity was 82% for >= 1 unstable factor and 99% for >= 2 factors.
• Sensitivity was only 27.5% for >= 1 unstable factor and 7.5% for >= 2 factors.
Limitations:
• The poor sensitivity and positive predictive value indicates that factors other than patient stability are important influences for an adverse outcome.
Specialty: Infectious Diseases, Pulmonology
ICD-10: ,
