New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality
New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality
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DOI：
10.1136/thx.2008.109785
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发表时间：
2009-12-01
期刊：
影响因子：
10
通讯作者：
Hoeffken, G.
中科院分区：
文献类型：
--
作者：
Ewig, S.;Birkner, N.;Hoeffken, G.
工作背景：德国医疗保健质量计划数据库，包括2年期间社区获得性肺炎（CAP）住院患者的数据方法：分析2005年和2006年388406例患者的临床资料，包括：（1）发病率;（2）结局;（3）CRB-65的表现（C，精神错乱; R，呼吸频率≥ 30/min; B，收缩压≥ 60岁，2年内。死亡率（13.72%和14.44%）高于先前研究报告的死亡率。CRB-65 RC以三级模式准确预测死亡（CRB-65 RC 1中死亡率为2.40%，CRB-65 RC 2中死亡率为13.43%，CRB-65 RC 3中死亡率为34.39%）。在所有风险类别中，入院后的第一天始终与最高的死亡风险相关。只有少数死亡的患者在住院期间接受了机械通气（15.74%）。结论：住院CAP基本上是一种老年人的疾病，死亡率高于以前的报道。它具有相当大的早期死亡风险，即使在低风险患者中也是如此。CRB-65是一种简单而强大的CAP严重程度评估工具。住院CAP是慢性衰弱患者中常见的终末事件，经常限制治疗递增。
Background: The database of the German programme for quality in healthcare including data of every hospitalised patient with community-acquired pneumonia (CAP) during a 2-year period (n = 388 406 patients in 2005 and 2006) was analysed.Methods: End points of the analysis were: (1) incidence; (2) outcome; (3) performance of the CRB-65 (C, mental confusion; R, respiratory rate >= 30/min; B, systolic blood pressure = 60 years over 2 years. Mortality (13.72% and 14.44%) was higher than reported in previous studies. The CRB-65 RCs 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 hospitalisation (15.74%).Conclusions: Hospitalised 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. Hospitalised CAP is a frequent terminal event in chronic debilitated patients, and a limitation of treatment escalation is frequently applied.