Prospective multicentre survey on clinical features and management approach to community-acquired pneumonia in emergency departments in Italy: focus on hospital admitted cases

The correct management of community-acquired pneumonia (CAP) in emergency departments (EDs) is pivotal for the proper use of hospital resources and to ensure optimal management for each patient. Despite a significant body of relevant literature, several doubts remain, namely related to the optimal definition of clinical severity, the most useful criteria for sound patient allocation, the value of immediate microbiological diagnosis, and the criteria for treatment choice. METHODS: Prospective, multicentric cohort study, enrolling for a period of 24 months all the CAP cases referred to 9 EDs in Italian hospitals. For every enrolled patient demographics and clinical data were collected and clinical severity was defined using and comparing three different predictive rules. RESULTS: Of 1214 patients who enrolled, 844 were admitted to hospital. Of these, the mean age was 64 and only 56.9% were over 65 years. Nearly 50% of patients admitted had low scores of severity but over 70% had one or more comorbidities. Overall mortality was 8.5%. Streptococcus pneumoniae was the most represented aetiological agent, but globally the yield of microbiological work up was scant (16%). COMMENT: In a real-life study condition, predictive rules, very attractive for prognosis, are not useful for clinicians to decide on admission of a patient with CAP, mainly when compared with assessment of comorbidities.