Thorax 2000;55:1040-1045 ( December )

A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales

J C G Simpson^a, J T Macfarlane^b, J Watson^c, M A Woodhead^d, on behalf of the British Thoracic Society Research Committee and Public Health Laboratory Service

^a Stepping Hill Hospital, Stockport SK7 2JE, UK, ^b Respiratory Medicine, City Hospital, Nottingham NG5 1PB, UK, ^c PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK, ^d Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester M13 9WL, UK

Correspondence to: Dr M Woodhead woodhead{at}central.cmht.nwest.nhs.uk

Received 10 April 2000; Returned to authors 14 June 2000; Revised version received 10 August 2000; Accepted for publication 22 August 2000

BACKGROUNDThe aim of this study was to describe the frequency, causal pathogens, management, and outcome of a population of young adults who died from community acquired pneumonia (CAP).
METHODSPneumonia deaths in England and Wales in adults aged 15-44 were identified between September 1995 and August 1996. Patients with underlying chronic illness including HIV infection were excluded. Clinical details for each case were collected from the hospital and general practitioner records.
RESULTSDeath from CAP was identified in 27 previously well young adults (1.2 per million population per year). Twenty were known to have consulted a GP for this illness. Nine received antibiotics before hospital admission. A causative pathogen was identified in 17 cases (Streptococcus pneumoniae in eight). Bacteraemia was present in seven. All patients who reached a hospital ward received antibiotics (69% within two hours of admission). The British Thoracic Society antibiotic guidelines for severe CAP were followed in only 10 cases. Cardiac arrest at home or on arrival at hospital occurred in six cases, one of whom was successfully resuscitated. Of the remaining 21 patients, 71% had two or more markers of severe CAP. All 22 who were admitted reached an intensive care unit, but 11 of these required transfer to another hospital for some aspect of intensive care. One third of patients died within 24 hours of presenting to the hospital.
CONCLUSIONSDeath from CAP in previously fit young adults still occurs. While some deaths might be preventable by better patient management, most are unlikely to be preventable by current management practices.


Keywords: community acquired pneumonia; death; young adults

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© 2000 by Thorax
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