Time to clinical stability in patients hospitalized with community-acquired pneumonia - Implications for practice guidelines
Time to clinical stability in patients hospitalized with community-acquired pneumonia - Implications for practice guidelines
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DOI：
10.1001/jama.279.18.1452
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发表时间：
1998-05-13
影响因子：
120.7
通讯作者：
Singer, DE
中科院分区：
文献类型：
--
作者：
Halm, EA;Fine, MJ;Singer, DE
上下文。-许多团体已经制定了缩短肺炎住院时间的指导方针，以降低成本，但肺炎住院患者临床稳定之前的时间长度尚未确定。描述社区获得性肺炎患者生命体征、饮食能力和精神状态异常的解决时间，并评估达到稳定后的临床结果。-前瞻性、多中心、观察性队列研究。-马萨诸塞州波士顿、宾夕法尼亚州匹兹堡和新斯科舍省哈利法克斯的三所大学和一所社区教学医院。- 686名因社区获得性肺炎住院的成年人。主要观察指标：生命体征消退时间、饮食能力、精神状态、住院时间、入住重症监护、冠状动脉护理或遥测病房的时间。-心率（小于或等于100次/分钟）和收缩压（大于或等于90毫米汞柱）达到稳定的中位时间为2天，呼吸频率（小于或等于24次/分钟）、氧饱和度（大于或等于90%）和体温（小于或等于37.2摄氏度[99华氏度]）为3天。最宽松的稳定定义为3天，最保守的稳定定义为7天，达到总体临床稳定的中位时间为3天。重症肺炎患者在发病时需要更长的时间才能达到稳定。一旦病情稳定，1%或更少的病例出现需要重症监护、冠状动脉护理或遥测监测的临床恶化。65%至86%的患者在达到稳定后住院超过1天，而在稳定后1天内改用口服抗生素的患者不到29%至46%，具体取决于稳定性的定义。-我们对肺炎稳定所需时间的估计和明确的稳定定义标准可以提供基于证据的最佳住院时间估计，并概述了提高住院病人管理效率的临床可行方法。
Context.-Many groups have developed guidelines to shorten hospital length of stay in pneumonia in order to decrease costs, but the length of time until a patient hospitalized with pneumonia becomes clinically stable has not been established.Objective.-To describe the time to resolution of abnormalities in vital signs, ability to eat, and mental status in patients with community-acquired pneumonia and assess clinical outcomes after achieving stability.Design.-Prospective, multicenter, observational cohort study.Setting.-Three university and 1 community teaching hospital in Boston, Mass, Pittsburgh, Pa, and Halifax, Nova Scotia.Patients.-Six hundred eighty-six adults hospitalized with community-acquired pneumonia.Main Outcome Measures-Time to resolution of vital signs, ability to eat, mental status, hospital length of stay, and admission to an intensive care, coronary care, or telemetry unit.Results.-The median time to stability was 2 days for heart rate (less than or equal to 100 beats/min) and systolic blood pressure (greater than or equal to 90 mm Hg), and 3 days for respiratory rate (less than or equal to 24 breaths/min), oxygen saturation (greater than or equal to 90%), and temperature (less than or equal to 37.2 degrees C [99 degrees F]). The median time to overall clinical stability was 3 days for the most lenient definition of stability and 7 days for the most conservative definition. Patients with more severe cases of pneumonia at presentation took longer to reach stability. Once stability was achieved, clinical deterioration requiring intensive care, coronary care, or telemetry monitoring occurred in 1% of cases or fewer. Between 65% to 86% of patients stayed in the hospital more than 1 day after reaching stability, and fewer than 29% to 46% were converted to oral antibiotics within 1 day of stability, depending on the definition of stability.Conclusions.-Our estimates of time to stability in pneumonia and explicit criteria for defining stability can provide an evidence-based estimate of optimal length of stay, and outline a clinically sensible approach to improving the efficiency of inpatient management.