Thorax 64:1062-1069 doi:10.1136/thx.2008.109785
  • Respiratory infection

New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality

Open Access
  1. S Ewig1,
  2. N Birkner2,
  3. R Strauss3,
  4. E Schaefer2,
  5. J Pauletzki4,
  6. H Bischoff5,
  7. P Schraeder2,
  8. T Welte7,
  9. G Hoeffken
  1. 1
    Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, Germany
  2. 2
    BQS Bundesgeschäftsstelle Qualitätssicherung, Duesseldorf, Germany
  3. 3
    Universitaetsklinikum Erlangen, Germany
  4. 4
    SRH Kliniken Heidelberg, Germany
  5. 5
    Thoraxklinik Heidelberg, Germany
  6. 6
    Medizinische Hochschule Hannover, Germany
  7. 7
    Universitaetsklinikum Carl Gustav Carus, Fachkrankehaus Coswig, Germany
  1. Correspondence to Dr N Birkner, BQS Bundesgeschäftsstelle Qualitätssicherung gGmbH, Kanzlerstr. 4, D-40472 Düsseldorf, Germany; norbert.birkner{at}
  • Received 12 November 2008
  • Accepted 27 April 2009
  • Published Online First 18 May 2009


Background: The database of the German programme for quality in healthcare including data of every hospitalised patient with community-acquired pneumonia (CAP) during a 2-year period (n = 388 406 patients in 2005 and 2006) was analysed.

Methods: End points of the analysis were: (1) incidence; (2) outcome; (3) performance of the CRB-65 (C, mental confusion; R, respiratory rate ⩾30/min; B, systolic blood pressure <90 mm Hg or diastolic blood pressure ⩽60 mm Hg; 65, age ⩾65 years) score in predicting death; and (4) lack of ventilatory support as a possible indicator of treatment restrictions. The CRB-65 score was calculated, resulting in three risk classes (RCs).

Results: The incidence of hospitalised CAP was 2.75 and 2.96 per 1000 inhabitants/year in 2005 and 2006, respectively, higher for males (3.21 vs 2.52), and strongly age related, with an incidence of 7.65 per 1000 inhabitants/year in patients aged ⩾60 years over 2 years. Mortality (13.72% and 14.44%) was higher than reported in previous studies. The CRB-65 RCs accurately predicted death in a three-class pattern (mortality 2.40% in CRB-65 RC 1, 13.43% in CRB-65 RC 2 and 34.39% in CRB-65 RC 3). The first days after admission were consistently associated with the highest risk of death throughout all risk classes. Only a minority of patients who died had received mechanical ventilation during hospitalisation (15.74%).

Conclusions: Hospitalised CAP basically is a condition of the elderly associated with a higher mortality than previously reported. It bears a considerable risk of early mortality, even in low risk patients. CRB-65 is a simple and powerful tool for the assessment of CAP severity. Hospitalised CAP is a frequent terminal event in chronic debilitated patients, and a limitation of treatment escalation is frequently applied.


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