Pneumonia
Conditions
Keywords
risk factors, Community acquired pneumonia
Brief summary
There is no gold standard when diagnosing of pneumonia. The variability of clinical signs and symptoms make it difficult to distinguish pneumonia from other causes of respiratory conditions. Well defined characteristics upon arrival to the emergency department will contribute to the better and quicker diagnosis of community-acquired pneumonia.
Detailed description
Currently, pneumonia diagnosis is primarily based on clinical symptoms such as cough, shortness of breath, chest pain, fever and sputum production, combined with X-ray of the lungs, relevant blood tests and microbiological analysis of sputum samples. The X-ray is an imprecise diagnostic tool, and results from sputum assays are first available after 2 days. In the elderly, pneumonia presents with clinically differing signs such as delirium, malnutrition, and there may be an absence of fever, cough and dyspnea. The physical examination is also challenged by a broad variety of atypical symptoms like headache, dry cough and gastrointestinal symptoms in the form of nausea, vomiting or diarrhea. Our hypothesis is that well-defined clinical characteristics upon arrival to the emergency department will contribute to the better and quicker diagnosis of pneumonia. The aim is to identify the information available upon arrival to the Emergency Department that contributes to diagnosis and prognosis of community-acquired-pneumonia. The objectives are: 1. Identify the information available upon arrival that correlates to the diagnosis of community-acquired pneumonia 2. Identify the information available upon arrival that correlates to severity of community-acquired pneumonia
Interventions
OTHERClinical Assessment within 4 hours of admission
Demographics, Symptoms, Severity scores (Triage at admission, confusion, urea, respiration, blood pressure, age (CURB 65) and pneumonia severity score (PSI), clinical parameters, blood testing, chest x-rays, comorbidities, electro-cardiogram
Sponsors
University of Southern Denmark
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients \> 18 years old * Patients suspected with CAP by the attending physician. The physician will base his/her suspicion on e.g. clinical symptoms such as cough, increased sputum production, chest tights, dyspnea and fever\>38C, and indication for x-ray.
Exclusion criteria
* If the attending physician considers that participation will delay a life-saving treatment or patient needs direct transfer to the intensive care unit. * Admission within the last 14 days * Verified COVID-19 disease within 14 days before admission * Pregnant women * Severe immunodeficiencies: Primary immunodeficiencies and secondary immunodeficiencies (HIV positive CD4 \<200, Patients receiving immunosuppressive treatment (ATC L04A), Corticosteroid treatment (\>20 mg/day prednisone or equivalent for \>14 days within the last 30 days), Chemotherapy within 30 days)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnosis of community acquired pneumonia | expert assessment within 3 months after patient discharge from the hospital | The percentage of patients diagnosed with community-acquired pneumonia determined by an expert panel. This outcome measure is a binary variable - verified pneumonia or no pneumonia. The expert panel consists of two independent consultants from the emergency department with experience in infection and emergency medicine, who individually will determine whether or not the patient admitted with suspected community-acquired pneumonia had the diagnosis. The diagnosis will be based on all available relevant information from the patient medical record within 48 hours from admission including computed tomography. A standardized template will be used. Disagreement will be discussed until a consensus is reached. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intensive care unit (ICU) treatment: | within 60 days from admission to the emergency department | Transfer to the intensive care unit will be recorded during the current hospitalization as a binary variable (transferred/not-transferred) |
| Length of hospital stay | within 60 days from current admission to the emergency department | Defined as the time (in days) spent in hospital during the current admission. Measured in days from admission to hospital discharge. Discharge date minus admission date |
| 30-days mortality | 30 days from the admission to the emergency department | Mortality within 30 days from admission to the Emergency Department |
| Readmission | within 30 days from the discharge to the hospital | If a subject is admitted over a 30 day period after the current hospitalization discharge measured as a binary outcome Re-admissions/not re-admissions. |
| In-hospital mortality | within 60 days from admission to the emergency department | Patient mortality during the current hospitalization. Binary outcome - Died/ Not died |
Other
| Measure | Time frame | Description |
|---|---|---|
| 90 days mortality | within 90 days from admission to emergency department | binary |
| Bacteriuria | within 4 hours from admission | Binary outcome defined by the microbiologist on urine culture analysis |
| CURB-65 score for predicting mortality in community-acquired-pneumonia | within 4 hours from admission | CURB-65 score consists of: Confusion of new onset, Blood Urea nitrogen greater than 7 mmol/L (19 mg/dL), respiratory rate of 30 breaths per minute or greater, blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less and age 65 or older. The score stratify patients to groups 1 (mild pneumonia), 2 (moderate pneumonia) and 3-5 (severe pneumonia). |
| Pneumonia severity index (PSI) | : within 4 hours from admission | Risk classes to predict the severity of pneumonia. Scores are given based on demographics, comorbidity, clinical measurements and physical Exam Findings (\<70 = Risk Class II, 71-90 = Risk Class III, 91-130 = Risk Class IV, \>130 = Risk Class V) |
| Microbial agents | results within 7 days from sputum sample collection | Microbial agents (bacteria and viruses) identified in standard culture, PCR and multiplex PCR. Sputum samples are collected within 1 hour from patient admission. Descriptive findings in percentage will be registered. |
| Level of infection markers | results within 4 hour from admission | Concentration of serum PCT and suPAR are collected in connection to routine blood tests within 1 hour from admission. |
| Level of markers of lung injury | within 4 hours from admission | Concentration of serum surfactant protein D, KL-6 and YKL-40 |
Countries
Denmark
Outcome results
None listed