Article Text

other Versions


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


                    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.

                    Statistics from

                    Request permissions

                    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

                    Linked Articles

                    • Editorial
                      Antoni Torres Rosario Menéndez
                    • Airwaves
                      Wisia Wedzicha