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criteria for hospitalization of patients with pneumonia
Criteria:
1) elderly: age > 65 years
2) significant comorbidity
a) renal disease
b) heart disease
c) lung disease
d) diabetes mellitus
e) neoplasm
f) immunosuppression
3) leukopenia (< 5000 WBC/mL) NOT attributable to known condition
4) virulent pathogen suspected
a) Staphylococcus aureus
b) gram-negative bacillus
c) anaerobe
5) suppurative complications
a) empyema
b) arthritis
c) endocarditis
6) failure of outpatient management
7) inability to take oral medication
8) vital signs
a) tachypnea (> 30 breaths/min)
b) tachycardia (> 140 beats/min)
c) hypotension (systolic BP < 90 mm Hg)
9) hypoxemia (arterial pO2 < 60 mm Hg)
10) alteration in mental status
11) nursing home residents need not be hospitalized if: [2]
a) able to eat & drink
b) pulse < 100 minute
c) respiratory rate < 30/min
d) systolic blood pressure > 90 mm Hg
e) paO2 > 92%, or > 90% with chronic lung disease
12) change in status for the worse warrents hospitalization
* treatment with levofloxaxin 500 mg QD for 10 days
Related
hospitalization
pneumonia (PNA)
General
criteria
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1187
- Loeb M et al,
Effect of a clinical pathway to reduce hospitalizations in
nursing home residents with pneumonia, A randomized controlled
trial.
JAMA 2006; 295:2503
PMID: 16757722