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In 1930, pneumonia was the third most frequent cause of death in the USA. Now almost a century later, and despite the introduction of antibiotics in the 1950s, pneumonia remains the fourth most common cause of death worldwide.1 Community-acquired pneumonia (CAP) represents a major burden in terms of morbidity, mortality and health cost, as well as days of work lost.
In the last 10 years, guidelines for management of CAP have been published.2–4 One of the objectives of the guidelines is to improve outcomes (including mortality) when implemented. This was demonstrated, for example, by Dean et al,5 showing a reduction in mortality from 14.2% to 11% in a series of hospitals in the USA after implementation of the 2001 American Thoracic Society CAP guidelines.
The British Thoracic Society (BTS) guidelines were published in 20092 and they advised three key points for CAP quality standards: (1) to perform a chest X-ray within 4 hours of presentation, (2) to perform a mortality risk assessment using the CURB65 score and (3) to administer the first dosage of antibiotics within the first 4 hours after emergency department (ED) arrival. In parallel with the 2009 publication the BTS started a CAP audit programme. The audit was conducted from 2009 to 2012 and then subsequently in 2014.6 A total of 218 institutions …