Measuring symptomatic and functional recovery in patients with community-acquired pneumonia
Measuring symptomatic and functional recovery in patients with community-acquired pneumonia
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DOI：
10.1046/j.1525-1497.1997.00074.x
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发表时间：
1997-07-01
影响因子：
5.7
通讯作者：
Singer, DE
中科院分区：
文献类型：
--
作者：
Metlay, JP;Fine, MJ;Singer, DE
目的：确定社区获得性肺炎患者的症状缓解率和恢复到病前健康状态的比率，并评估这些结果与卫生保健利用的相关性。设计：一项前瞻性、多中心队列研究。576名成人（年龄大于或等于18岁），有肺炎的临床和放射学证据，通过经验证的肺炎严重程度指数判断为死亡风险低。五种症状的存在和严重程度通过在四个时间点进行的问卷调查记录（咳嗽、疲劳、呼吸困难、咳痰和胸痛）：从影像学诊断为肺炎后0、7、30和90天，将症状总评分制表为5个个体严重程度评分的总和。患者还提供了对医学结局研究36项简明健康调查表（SF-36）的回答，并报告了门诊医生访视的次数和原因。在初次访谈时获得了肺炎发作前30天（肺炎前期）的症状和健康状况。除胸膜炎性胸痛外，所有症状在30天时仍普遍报告，90天时每种症状的患病率仍接近肺炎前水平的两倍。来自SF-36表的身体健康指标在就诊时显著下降，但在所有三个随访时间段内继续改善。在第7天或第30天症状评分升高的患者在随后的第30天或第90天访谈中分别更有可能报告肺炎相关的门诊治疗，结论：对于许多肺炎患者，疾病特异性症状的缓解和病前身体健康状况的恢复需要超过30天。症状的延迟缓解与门诊医生就诊的增加有关。
OBJECTIVE: To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community-acquired pneumonia.DESIGN: A prospective, multicenter cohort study.SETTING: Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff-model health maintenance organization.PATIENTS: Five hundred seventy-six adults (aged greater than or equal to 18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying.MEASUREMENTS AND MAIN RESULTS: The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia, A summary symptom score was tabulated as the sum of the five individual severity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presentation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively,CONCLUSIONS: Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits.