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Bernabeu-Wittel M, Ternero-Vega JE, Díaz-Jiménez P, Conde-Guzmán C, Nieto-Martín MD, Moreno-Gaviño L, Delgado-Cuesta J, Rincón-Gómez M, Giménez-Miranda L, Navarro-Amuedo MD, Muñoz-García MM, Calzón-Fernández S, Ollero-Baturone M. Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks. Arch Gerontol Geriatr 2020; 91:104240. [PMID: 32877792 PMCID: PMC7446617 DOI: 10.1016/j.archger.2020.104240] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/01/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
Elderly people are more severely affected by COVID-19. Nevertheless scarce information about specific prognostic scores for this population is available. The main objective was to compare the accuracy of recently developed COVID-19 prognostic scores to that of CURB-65, Charlson and PROFUND indices in a cohort of 272 elderly patients from four nursing homes, affected by COVID-19. Accuracy was measured by calibration (calibration curves and Hosmer-Lemeshov (H-L) test), and discriminative power (area under the receiver operation curve (AUC-ROC). Negative and positive predictive values (NPV and PPV) were also obtained. Overall mortality rate was 22.4 %. Only ACP and Shi et al. out of 10 specific COVID-19 indices could be assessed. All indices but CURB-65 showed a good calibration by H-L test, whilst PROFUND, ACP and CURB-65 showed best results in calibration curves. Only CURB-65 (AUC-ROC = 0.81 [0.75-0.87])) and PROFUND (AUC-ROC = 0.67 [0.6-0.75])) showed good discrimination power. The highest NPV was obtained by CURB-65 (95 % [90-98%]), PROFUND (93 % [77-98%]), and their combination (100 % [82-100%]); whereas CURB-65 (74 % [51-88%]), and its combination with PROFUND (80 % [50-94%]) showed highest PPV. PROFUND and CURB-65 indices showed the highest accuracy in predicting death-risk of elderly patients affected by COVID-19, whereas Charlson and recent developed COVID-19 specific tools lacked it, or were not available to assess. A comprehensive clinical stratification on two-level basis (basal death risk due to chronic conditions by PROFUND index, plus current death risk due to COVID-19 by CURB-65), could be an appropriate approach.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain; Department of Medicine, University of Seville, Spain. https://mobile.twitter.com/mximowittel?lang=en
| | - J E Ternero-Vega
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - P Díaz-Jiménez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - C Conde-Guzmán
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Nieto-Martín
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Moreno-Gaviño
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - J Delgado-Cuesta
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M Rincón-Gómez
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - L Giménez-Miranda
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M D Navarro-Amuedo
- Infectious Diseases Department, University Hospital Virgen del Rocío, Seville, Spain
| | - M M Muñoz-García
- Bermejales Primary Care Center, Primary Care District of Seville, Spain
| | - S Calzón-Fernández
- Epidemiology and Public Health Department, Primary Care District of Seville, Spain
| | - M Ollero-Baturone
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Spain
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Buss IM, Birkhamshaw E, Innes MA, Magadoro I, Waitt PI, Rylance J. Validating a novel index (SWAT-Bp) to predict mortality risk of community-acquired pneumonia in Malawi. Malawi Med J 2018; 30:230-235. [PMID: 31798800 PMCID: PMC6863414 DOI: 10.4314/mmj.v30i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia is a major cause of mortality worldwide. Early assessment and initiation of management improves outcomes. In higher-income countries, scores assist in predicting mortality from pneumonia. These have not been validated for use in most lower-income countries. AIM To validate a new score, the SWAT-Bp score, in predicting mortality risk of clinical community-acquired pneumonia amongst hospital admissions at Queen Elizabeth Central Hospital, Blantyre, Malawi. METHODS The five variables constituting the SWAT-Bp score (male [S]ex, muscle [W]asting, non-[A]mbulatory, [T]emperature (>38°C or <35°C) and [B]lood [p]ressure (systolic<100 and/or diastolic<60)) were recorded for all patients with clinical presentation of a lower respiratory tract infection, presumed to be pneumonia, over four months (N=216). The sensitivity and specificity of the score were calculated to determine accuracy of predicting mortality risk. RESULTS Median age was 35 years, HIV prevalence was 84.2% amongst known statuses, and mortality rate was 12.5%. Mortality for scores 0-5 was 0%, 8.5%, 12.7%, 19.0%, 28.6%, 100% respectively. Patients were stratified into three mortality risk groups dependent on their score. SWAT-Bp had moderate discriminatory power overall (AUROC 0.744). A SWAT-Bp score of ≥2 was 82% sensitive and 51% specific for predicting mortality, thereby assisting in identifying individuals with a lower mortality risk. CONCLUSION In this validation cohort, the SWAT-Bp score has not performed as well as in the derivation cohort. However, it could potentially assist clinicians identifying low-risk patients, enabling rapid prioritisation of treatment in a low-resource setting, as it helps contribute towards individual patient risk stratification.
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Affiliation(s)
- Imogen M Buss
- Department of Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Edmund Birkhamshaw
- Department of Infectious Diseases, Heartlands Hospital, Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Michael A Innes
- General Practitioner, Stirchley Medical Practice, Telford, United Kingdom
| | - Itai Magadoro
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Peter I Waitt
- Acute Medical Unit, Wirrall University Hospital Foundation Trust, United Kingdom
| | - Jamie Rylance
- Senior Clinical Lecturer in respiratory medicine, Liverpool School of Tropical Medicine, United Kingdom.,Lung Health Group Lead, Malawi-Liverpool-Wellcome Program, Blantyre, Malawi
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Hariri G, Tankovic J, Boëlle PY, Dubée V, Leblanc G, Pichereau C, Bourcier S, Bigé N, Baudel JL, Galbois A, Ait-Oufella H, Maury E. Are third-generation cephalosporins unavoidable for empirical therapy of community-acquired pneumonia in adult patients who require ICU admission? A retrospective study. Ann Intensive Care 2017; 7:35. [PMID: 28341979 PMCID: PMC5366988 DOI: 10.1186/s13613-017-0259-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Third-generation cephalosporins (3GCs) are recommended for empirical antibiotic therapy of community-acquired pneumonia (CAP) in patients requiring ICU admission. However, their extensive use could promote the emergence of extended-spectrum beta-lactamases-producing Enterobacteriaceae. Our aim was to assess whether the use of 3GCs in patients with CAP requiring ICU admission was justified. METHODS We assessed all patients with CAP who required ICU admission during a 7-year period. We recorded empirical and definitive antibiotic therapies and susceptibility of causative pathogens. Amoxicillin, amoxicillin/clavulanate (A/C) susceptibilities as well as amikacin susceptibility of A/C-resistant strains were recorded. RESULTS From January 2007 to March 2014, 391 patients were included in the study. Empirical 3GCs were used in 215 patients (55%). Among 267 patients with microbiologically documented CAP (68%), 241 received a beta-lactam as definitive therapy, and of those, 3CGs were chosen for 43 patients (18%). Amoxicillin or A/C was active against isolated pathogens in 159 patients (66%), while 39 patients (16%) required a beta-lactam with a broader spectrum than 3GCs. Ninety-four per cent of A/C-resistant strains were amikacin susceptible. CONCLUSIONS In ICU patients with CAP, 3GCs given on an empirical basis are changed, according to microbiological documentation, for another beta-lactam in 82% of cases especially to A/C in the absence of resistance risk factor. In patients evidencing risk factors for A/C-resistant strains infection, 3GCs or antipseudomonal beta-lactams including carbapenem associated with amikacin in the most severe patients seem a relevant empirical antibiotic therapy. This strategy could decrease 3GCs' use.
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Affiliation(s)
- Geoffroy Hariri
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Jacques Tankovic
- Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre-Yves Boëlle
- Institut Pierre-Louis d'Epidémiologie et de Santé Publique, U 1136, Inserm, 75012, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Vincent Dubée
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Guillaume Leblanc
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Simon Bourcier
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Naike Bigé
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Jean-Luc Baudel
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France
| | - Arnaud Galbois
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,Réanimation Polyvalente, HP Claude Galien, 91480, Quincy-sous-Sénart, France
| | - Hafid Ait-Oufella
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du faubourg Saint-Antoine, 75571, Paris, France. .,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, U 1136, Inserm, 75012, Paris, France. .,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.
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Severson C, Renstrom C, Fitzhugh M. Health promotion, risk stratification, and treatment options to decrease hospitalization rates for community-acquired pneumonia in adults. J Am Assoc Nurse Pract 2014; 26:537-49. [PMID: 24170698 PMCID: PMC7166367 DOI: 10.1002/2327-6924.12072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 07/12/2012] [Indexed: 11/10/2022]
Abstract
PURPOSE Community-acquired pneumonia (CAP) is a serious illness and hospitalization for this illness is expensive. There is much the nurse practitioner (NP) can do to prevent and manage this illness. DATA SOURCES Review of current literature, medical/nursing references, and data from the healthcare utilization project (HCUP). CONCLUSIONS The use of health promotion, risk stratification, and current evidence-based treatment guidelines can help to decrease hospitalization rates for CAP for adults. IMPLICATIONS FOR PRACTICE NPs are experts at health promotion and evidence-based practice. Adhering to these practices and using risk stratification, NPs can help to further decrease hospitalization rates for CAP lowering healthcare costs related to this serious illness.
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Affiliation(s)
| | | | - Meg Fitzhugh
- College of Nursing and Allied Health, Northwestern State UniversityShreveportLouisiana
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Gupta D, Agarwal R, Aggarwal AN, Singh N, Mishra N, Khilnani GC, Samaria JK, Gaur SN, Jindal SK. Guidelines for diagnosis and management of community- and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations. Lung India 2012; 29:S27-62. [PMID: 23019384 PMCID: PMC3458782 DOI: 10.4103/0970-2113.99248] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dheeraj Gupta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - G. C. Khilnani
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - J. K. Samaria
- Department of Pulmonary Medicine, Indian Chest Society, India
| | - S. N. Gaur
- Department of Pulmonary Medicine, National College of Chest Physicians, India
| | - S. K. Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - for the Pneumonia Guidelines Working Group
- Pneumonia Guidelines Working Group Collaborators (43) A. K. Janmeja, Chandigarh; Abhishek Goyal, Chandigarh; Aditya Jindal, Chandigarh; Ajay Handa, Bangalore; Aloke G. Ghoshal, Kolkata; Ashish Bhalla, Chandigarh; Bharat Gopal, Delhi; D. Behera, Delhi; D. Dadhwal, Chandigarh; D. J. Christopher, Vellore; Deepak Talwar, Noida; Dhruva Chaudhry, Rohtak; Dipesh Maskey, Chandigarh; George D’Souza, Bangalore; Honey Sawhney, Chandigarh; Inderpal Singh, Chandigarh; Jai Kishan, Chandigarh; K. B. Gupta, Rohtak; Mandeep Garg, Chandigarh; Navneet Sharma, Chandigarh; Nirmal K. Jain, Jaipur; Nusrat Shafiq, Chandigarh; P. Sarat, Chandigarh; Pranab Baruwa, Guwahati; R. S. Bedi, Patiala; Rajendra Prasad, Etawa; Randeep Guleria, Delhi; S. K. Chhabra, Delhi; S. K. Sharma, Delhi; Sabir Mohammed, Bikaner; Sahajal Dhooria, Chandigarh; Samir Malhotra, Chandigarh; Sanjay Jain, Chandigarh; Subhash Varma, Chandigarh; Sunil Sharma, Shimla; Surender Kashyap, Karnal; Surya Kant, Lucknow; U. P. S. Sidhu, Ludhiana; V. Nagarjun Mataru, Chandigarh; Vikas Gautam, Chandigarh; Vikram K. Jain, Jaipur; Vishal Chopra, Patiala; Vishwanath Gella, Chandigarh
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Eurich DT, Majumdar SR, Marrie TJ. Population-based cohort study of outpatients with pneumonia: rationale, design and baseline characteristics. BMC Infect Dis 2012; 12:135. [PMID: 22709357 PMCID: PMC3407480 DOI: 10.1186/1471-2334-12-135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 06/18/2012] [Indexed: 12/17/2022] Open
Abstract
Background The vast majority of research in the area of community-acquired pneumonia (CAP) has been based on patients admitted to hospital. And yet, the majority of patients with CAP are treated on an ambulatory basis as outpatients, either by primary care physicians or in Emergency Departments. Few studies have been conducted in outpatients with pneumonia, and there is a paucity of data on short and long term morbidity or mortality and associated clinical correlates in this group of patients. Methods From 2000–2002, all CAP patients presenting to 7 Emergency Departments in Edmonton, Alberta, Canada were prospectively enrolled in a population-based registry. Clinical data, including pneumonia severity index (PSI) were collected at time of presentation. Patients discharged to the community were then followed for up to 5 years through linkage to the provincial administrative databases. The current report provides the rationale and design for the cohort, as well as describes baseline characteristics and 30-day morbidity and mortality. Results The total sample included 3874 patients. After excluding patients who were hospitalized, died or returned to the Emergency Department the same day they were initially discharged (n = 451; 12 %), and patients who could not be linked to provincial administrative databases (n = 237; 6 %), the final cohort included 3186 patients treated according to a validated clinical management pathway and discharged back to the community. Mean age was 51 (SD = 20) years, 53 % male; 4 % resided in a nursing home, 95 % were independently mobile, and 88 % had mild (PSI class I-III) pneumonia. Within 30-days, return to Emergency Department was common (25 %) as was hospitalization (8 %) and 1 % of patients had died. Conclusions To our knowledge, this represents the largest clinically-detailed outpatient CAP cohort assembled to date and will add to our understanding of the determinants and outcomes in this under-researched patient population. The rich clinical data along with the long term health care utilization and mortality will allow for the identification of novel prognostic indicators. Given how under studied this population is, the findings should aid clinicians in the routine care of their outpatients with pneumonia and help define the next generation of research questions.
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Affiliation(s)
- Dean T Eurich
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Protein C as an early biomarker to distinguish pneumonia from sepsis. J Crit Care 2011; 26:330.e9-12. [DOI: 10.1016/j.jcrc.2010.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/22/2010] [Accepted: 07/06/2010] [Indexed: 11/17/2022]
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Majumdar SR, Eurich DT, Gamble JM, Senthilselvan A, Marrie TJ. Oxygen saturations less than 92% are associated with major adverse events in outpatients with pneumonia: a population-based cohort study. Clin Infect Dis 2010; 52:325-31. [PMID: 21217179 DOI: 10.1093/cid/ciq076] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND patients with hypoxemia (blood oxygen saturation <90%) are usually hospitalized, although validated criteria (eg, the Pneumonia Severity Index [PSI]) suggest outpatient treatment is safe. We sought evidence to support or refute the practice. METHODS all patients in Edmonton, Alberta, Canada with pneumonia assessed at any of 7 emergency departments (EDs) and then discharged were enrolled in a population-based cohort study. The independent variable of interest was oxygen saturation; the outcome was the composite endpoint of 30-day mortality or hospitalization. RESULTS the study evaluated 2923 individuals with pneumonia who were treated as outpatients at any of 7 EDs. The patients' mean age (standard deviation [SD])was 52 (20) years; 47% were women; 74% were low risk (PSI Class I-II). The mean blood oxygen saturation (SD) was 95% (3%); 126 patients (4%) had blood oxygen saturations <90%, and 201 patients (7%) had blood oxygen saturations of 90%-92%. Over 30 days, 39 patients (1%) died and 252 (9%) reached the composite endpoint. Compared with patients with higher blood oxygen saturations, those discharged with saturations <90% had significantly (P < .001) higher rates of 30-day mortality (7 [6%] vs 32 [1%]), hospitalization (23 [18%] vs 201 [7%]), and composite endpoints (27 [21%] vs 225 [8%]). Blood oxygen saturation <90% was independently associated with 30-day mortality or hospitalization (adjusted odds ratio (OR), 1.7; 95% confidence interval (CI) 1.1-2.8; P = .032). If the saturation threshold for hospitalization was 92%, then there was no association with adverse events (adjusted OR 1.1, 95% CI 0.8-1.7, P = .48). Raising the admission threshold to 92% entails 1 additional hospitalization for every 14 patients discharged. CONCLUSIONS among outpatients with pneumonia, oxygen saturations <90% were associated with increased morbidity and mortality. Our results indicate a hospital admission threshold of <92% would be safer and clinically better justified.
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Affiliation(s)
- Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Raut M, Schein J, Mody S, Grant R, Benson C, Olson W. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin 2009; 25:2151-7. [PMID: 19601711 DOI: 10.1185/03007990903102743] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A recent study suggested that levofloxacin significantly reduces the hospital length of stay (LOS), by 0.5 days (p = 0.02), relative to moxifloxacin in patients with community-acquired pneumonia (CAP). The current analysis evaluated the potential economic impact of this half-day reduction in LOS. METHODS A cost model was developed to estimate the impact of a half-day reduction in LOS for CAP hospitalizations in the US. CAP incidence, hospitalization rate, and costs were obtained from published studies in PubMed and from publicly available government sources. The average daily cost of hospitalization was estimated for fixed costs, which comprise 59% of total inpatient costs. Costs from prior years were inflated to 2007 US dollars using the consumer price index. A range of cost savings, calculated using inpatient CAP costs from several studies, was extrapolated to the US CAP population. RESULTS Using the Centers for Disease Control National Hospital Discharge estimate of 5.3 days LOS for CAP, and an average cost (2007 $US) of $13,009 per CAP hospitalization, a daily fixed cost of $1448 was estimated. The resultant half-day reduction in costs associated with LOS was $724/hospitalization (range $457 to $846/hospitalization). When fixed and variable costs were considered, the estimated savings were $1227.27/episode. The incidence of CAP was estimated to be 1.9% (5.7 million cases/year based on current population census), and the estimated rate of CAP hospitalization was 19.6% (1.1 million annual hospitalizations). At $13,009/CAP-related hospitalization, total fixed inpatient costs of $8.6 billion annually were projected. The half-day reduction in LOS would therefore generate potential annual savings of approximately $813 million (range $513 million to $950 million). When total costs (fixed plus variable) were estimated, the mean savings for a half-day reduction would be approximately $1227/episode (range of $775 to $1434) or $1.37 billion annually in the US CAP population (range of $871 million to $1.6 billion). Limitations include the use of a single study for the estimation of fixed costs but a diversity of sources used for estimates of other variables, and lack of data with respect to the effects on costs of diagnostic-related groups, discounted contracts, and capitated payments. CONCLUSIONS A relatively small decrease in LOS in CAP can have a substantial cost impact, with estimated savings of $457 to $846 per episode or $500-$900 million annually. Additional evaluation is warranted for interpreting these cost-savings in the context of current antibiotic prescribing patterns.
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Affiliation(s)
- M Raut
- Ortho-McNeil Janssen Scientific Affairs LLC, Raritan, NJ 08869, USA.
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