MANAGEMENT OF PNEUMONIA BY EMERGENCY DEPARTMENT PHYSICIANS

This retrospective investigation assessed Emergency Department (ED) physician management of pneumonia with special reference to indications for hospitalization and outcome and antibiotic choice for discharged patients. Pneumonia was defined by the presence of pulmonary infiltrates designated by both the ED physician and a radiologist as consistent with this diagnosis. One hundred twenty-nine patients who fulfilled this definition were studied over a one-year period in 1988. Methods included univariate and multiple logistic regression (MLR) analyses. Patients not hospitalized were telephoned at ten to 30 days to assess outcome. Factors associated with hospitalization by MLR included old age, shortness of breath or cough, underlying diseases, and mental status changes. Twelve of 65 (18.5%) elderly persons were treated as outpatients with no deaths. Two (16.6%) required later hospitalization. Antibiotics for the outpatient elderly were primarily ampicillin/amoxycillin, erythromycin, and trimethoprimsulfamethoxazole. Data demonstrate factors relating to hospitalization in patients assessed by ED physicians. Selected elderly patients with pneumonia may be successfully treated as outpatients.