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New perspectives on community-acquired pneumonia in 388,406 patients.
  1. Santiago Ewig (sewig{at}versanet.de)
  1. Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, Germany
    1. Norbert Birkner (norbert.birkner{at}bqs-online.de)
    1. BQS Bundesgeschäftsstelle für Qualitätssicherung, Germany
      1. Richard Strauss (richard.strauss{at}med1.imed.uni-erlangen.de)
      1. Universitaetsklinikum Erlangen, Germany
        1. Elke Schaefer (elke.schaefer{at}bqs-online.de)
        1. BQS Bundesgeschäftsstelle für Qualitätssicherung, Germany
          1. Juergen Pauletzki (juergen.pauletzki{at}srh-kliniken.de)
          1. SRH Kliniken Heidelberg, Germany
            1. Helge Bischoff (helge.bischoff{at}thoraxklinik-heidelberg.de)
            1. Thoraxklinik Heidelberg, Germany
              1. Peter Schraeder (peter.schraeder{at}bqs-online.de)
              1. BQS Bundesgeschäftsstelle für Qualitätssicherung, Germany
                1. Tobias Welte (welte.tobias{at}mh-hannover.de)
                1. Medizinische Hochschule Hannover, Germany
                  1. Gert Hoeffken (gert.hoeffken{at}uniklinikum-dresden.de)
                  1. Universitaetsklinikum Carl Gustav Carus, Dresden; Fachkliniken Coswig, Germany

                    Abstract

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

                    Methods: Endpoints of the analysis were: 1) incidence 2) outcome 3) performance of CRB-65 score in predicting death 4) lack of ventilatory support as possible indicator of treatment restrictions. The CRB-65 score was calculated resulting in three risk classes (RC).

                    Results: The incidence of hospitalized CAP was 2.75 and 2.96 per 1,000 inhabitants/year in 2005 and 2006, respectively, higher for males (3.21 versus 2.52), and strongly age-related, with an incidence of 7.65 per 1,000 inhabitants/year in patients aged ≥ 60 years over two years. Mortality (13.72 and 14.44%) was higher than reported in previous studies. The CRB-65 risk classes (RC) 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 hospitalization (15.74%).

                    Conclusions: Hospitalized 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. Hospitalized CAP is a frequent terminal event in chronic debilitated patients, and a ceiling of care is frequently set.

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