|
Case mix for admissions with community-acquired pneumonia, overall and by year of admission: 1995 to 1999 versus 2000 to 2004 |
||||
| All admissions |
Admissions 1995 to 1999 |
Admissions 2000 to 2004 |
P value |
|
|
|
||||
| Admissions, n (%) |
17,869 (5.55) |
5,333 (1.65) |
12,536 (3.89) |
|
| Mean (SD) age, years |
61.6 (17.6) |
60.2 (17.5) |
62.2 (17.6) |
<0.001 |
| Age, n (%) |
||||
| <16 years |
336 (1.9) |
116 (2.2) |
220 (1.8) |
|
| 16 to 24 years |
475 (2.7) |
144 (2.7) |
331 (2.6) |
|
| 25 to 34 years |
830 (4.6) |
298 (5.6) |
532 (4.2) |
|
| 35 to 44 years |
1,300 (7.3) |
385 (7.2) |
915 (7.3) |
|
| 45 to 54 years |
2,184 (12.2) |
686 (12.8) |
1,498 (12.0) |
|
| 55 to 64 years |
3,453 (19.3) |
1,087 (20.4) |
2,366 (18.9) |
|
| 65 to 74 years |
5,034 (28.2) |
1,632 (30.6) |
3,402 (27.1) |
|
| 75 to 84 years |
3,837 (21.5) |
916 (17.2) |
2,921 (23.3) |
|
| 85+ years |
420 (2.4) |
69 (1.3) |
351 (2.8) |
|
| Gender male, n (%) |
10,271 (57.5) |
3,067 (57.5) |
7,204 (57.5) |
0.954 |
| Source of admission, n (%) |
<0.001 |
|||
| Ward, same hospital |
9,583 (53.6) |
2,941 (55.2) |
6,645 (53.0) |
|
| A&E, same hospital, clinic or home |
2,888 (16.2) |
788 (14.8) |
2,100 (16.8) |
|
| Other intermediate care area, same hospital |
649 (3.6) |
162 (3.0) |
487 (3.9) |
|
| HDU, same hospital |
1,867 (10.5) |
370 (6.9) |
1,497 (11.9) |
|
| ICU, same hospital |
198 (1.1) |
77 (1.5) |
121 (1.0) |
|
| ICU, other hospital |
1,355 (7.6) |
474 (8.9) |
881 (7.0) |
|
| HDU, other hospital |
157 (0.9) |
44 (0.8) |
113 (0.9) |
|
| Other hospital (not ICU or HDU) |
1,169 (6.5) |
477 (8.9) |
692 (5.5) |
|
| Past medical history, n (%) |
||||
| Severe liver problems |
219 (1.2) |
58 (1.1) |
161 (1.3) |
0.274 |
| Very severe cardiovascular disease |
334 (1.9) |
96 (1.8) |
238 (1.9) |
0.656 |
| Steroid treatment |
535 (3.0) |
183 (3.4) |
352 (2.8) |
0.025 |
| Severe respiratory problems |
1,265 (7.1) |
465 (8.7) |
800 (6.4) |
<0.001 |
| Chronic renal replacement therapy |
231 (1.3) |
87 (1.6) |
144 (1.2) |
0.009 |
| Primary reason for admission, n (%) |
<0.001 |
|||
| Viral pneumonia |
361 (2.0) |
164 (3.1) |
197 (1.6) |
|
| Bacterial pneumonia |
6,972 (49.0) |
2,270 (42.6) |
4,702 (37.5) |
|
| Pneumonia, no organism isolated |
10,536 (59.0) |
2,899 (54.3) |
7,637 (60.9) |
|
| Secondary reason for admission, n (%) |
<0.001 |
|||
| Pre-existing |
||||
| Obstructive airways disease |
1,309 (7.3) |
423 (7.9) |
886 (7.1) |
|
| Trauma |
119 (0.7) |
32 (0.6) |
87 (0.7) |
|
| Diabetes mellitus |
117 (0.7) |
49 (0.9) |
68 (0.5) |
|
| Chronic neuromuscular disorders |
99 (0.6) |
32 (0.6) |
67 (0.5) |
|
| Alcoholic cirrhosis |
124 (0.7) |
24 (0.5) |
100 (0.8) |
|
| Chronic renal failure |
184 (1.0) |
49 (0.9) |
135 (1.1) |
|
| Pulmonary fibrosis or fibrosing alveolitis |
112 (0.6) |
25 (0.5) |
87 (0.7) |
|
| Asthma attack |
176 (1.0) |
62 (1.2) |
114 (0.9) |
|
| Inhalation pneumonitis (gastrointestinal contents) |
56 (0.3) |
12 (0.2) |
44 (0.4) |
|
| Occurring as CAP complication |
||||
| Septic shock/septicaemia |
1,223 (6.8) |
389 (7.3) |
834 (6.6) |
|
| Pleural effusion |
122 (0.7) |
17 (0.3) |
105 (0.8) |
|
| Could be pre-existing or complication |
||||
| Acute renal failure |
877 (4.9) |
238 (4.5) |
639 (5.1) |
|
| Cardiac dysrhythmia |
246 (1.4) |
58 (1.1) |
188 (1.5) |
|
| Cardiac failure |
643 (3.6) |
213 (4.0) |
430 (3.4) |
|
| Cardiogenic shock |
59 (0.3) |
22 (0.4) |
37 (0.3) |
|
| Acute myocardial infarction |
218 (1.2) |
55 (1.0) |
163 (1.3) |
|
| Pulmonary embolus (thrombus) |
55 (0.3) |
23 (0.4) |
32 (0.3) |
|
| Status epilepticus or uncontrolled seizures |
91 (0.5) |
32 (0.6) |
59 (0.5) |
|
| Non-cardiogenic pulmonary oedema (ARDS) |
152 (0.9) |
45 (0.8) |
107 (0.9) |
|
| Other/none |
11,887 (66.5) |
3,533 (66.3) |
8,354 (66.6) |
|
| CPR prior to admission, n (%) |
1,080 (6.1) |
396 (7.5) |
684 (5.5) |
<0.001 |
| Mean (SD) SBP at admission, mmHg |
123.8 (30.9) |
123.5 (32.2) |
123.9 (30.4) |
0.486 |
| Mean (SD) heart rate at admission, bpm |
108.6 (24.6) |
110.1 (24.8) |
108.0 (24.5) |
<0.001 |
| Mechanically ventilated at admission, n (%) |
9,751 (54.6) |
3,009 (56.4) |
6,742 (53.8) |
0.001 |
| Sedated or paralysed and sedated for whole of first 24 hours, n (%) |
7,737 (43.3) |
2,676 (50.2) |
5,061 (40.4) |
<0.001 |
| Median (IQR) lowest total GCS if not sedated/paralysed |
15 (11–15) |
15 (11–15) |
15 (11–15) |
0.249 |
| Median (IQR) highest non-ventilated respiratory rate, breaths/minute |
32 (26–40) |
32 (25–40) |
33 (26–40) |
0.030 |
| Median (IQR) lowest PaO2, kPa |
9.0 (7.7–10.4) |
9.1 (7.7–10.6) |
8.9 (7.7–10.4) |
0.023 |
| Median (IQR) lowest pH |
7.3 (7.2–7.4) |
7.3 (7.2–7.4) |
7.3 (7.2–7.4) |
0.002 |
| Median (IQR) associated PaCO2, kPa |
6.7 (5.3–8.6) |
6.5 (5.2–8.3) |
6.7 (5.2–8.3) |
<0.001 |
| Mean (SD) APACHE II APSa |
15.31 (6.34) |
15.09 (6.25) |
15.40 (6.38) |
0.003 |
| Mean (SD) APACHE II scorea |
19.63 (6.89) |
19.37 (6.83) |
19.74 (6.91) |
<0.001 |
|
aAPACHE II exclusions: age <16 years; ICU stay <8 hours; readmissions within same hospital stay; transfers from another ICU; admissions following coronary artery bypass grafting; admissions for primary burns. A&E, accident and emergency; APACHE, Acute Physiology and Chronic Health Evaluation; APS, Acute Physiology Score; ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; CPR, cardiopulmonary resuscitation; GCS, Glasgow Coma score; HDU, high dependency unit; ICU, intensive care unit; IQR, interquartile range; PaCO2, arterial carbon dioxide tension; PaO2, arterial oxygen tension; SBP, systolic blood pressure; SD, standard deviation. | ||||
Woodhead et al. Critical Care 2006 10(Suppl 2):S1 doi:10.1186/cc4927 |
||||