Community-acquired pneumonia in older persons at the emergency department

(ENG) Study objectives: We evaluate the clinical presentation and outcomes at 30 days among elderly patients with community-acquired pneumonia (CAP) presenting to the emergency department (ED). Methods: This was a multicenter prospective study in a 14 Hospitalary ED of Catalunya, Spain, and the Principality of Andorra from January 20 to July 1, 2003. All patients aged 18 years or older admitted through the ED with a diagnosis of CAP were eligible for the study. Patients constituted 2 groups: (1) group I: younger than 65 years; (2) group II: 65 years or older. The diagnosis of CAP required the following: (1) new pulmonary infiltrate on chest radiograph; (2) clinical evidence suggestive of pneumonia, with presence of at least 2 of the following: temperature 38°C or greater, cough, purulent sputum, pleuritic chest pain, dyspnea, and confusion. Patients were excluded if they had an immunosuppressive illness, hospitalization in the past 14 days, or an alternative diagnosis. Data were collected for demographic information, triage time, previous or current antibiotic administration, time to antibiotic administration, initial antibiotic regimen, and clinical outcome at 30 days. The Sant Pau Ethic's Committee approved the study. Data were analyzed using SPSS software. Results: One thousand thirty-four patients were entered into the study. One hundred were eliminated for alternative diagnosis or immunosuppression. The mean age was 65.33 years (range 18 to 99 years, SD 19.82), and 62% of patients were older than 65 years. There was a predominance of incidence among men in subgroup II (58%, 65%, P=.060). Older patients had more comorbid conditions. In group II, only 58% had received an influenza vaccination. The clinical presentation in elderly patients was characterized by fewer symptoms; dyspnea was the symptom most differentiated into 2 groups (34%, 71%, P<.001). In the physical examination, we detected a statistically significant difference above the scores of the PSI: FR 30 or greater (11% versus 31%, P<.001), FC 125 or greater (9% versus 5%, P=.039), Tas (2%, 1%, P=.128), temperature less than 35°C or 40°C or greater (1%, 0,2%, P=.072). In group II the mean Barthel's index was 92 (SD 24). There were no significant differences above the results of laboratory tests except for the urea (13%, 41%, P<.001). We detected statistically significant differences about the PSI distribution: 71.2% of group II and 6% of group I was class IV to V (P<.001). There were no statistically significant differences above the initial empiric antimicrobial treatment after admission to the hospital (levofloxacin, amoxicilline-clavulanate). The mean time to administration of first dose of antibiotics was 4 hours 9 minutes (SD 3 hours) in group I and 4 hours 5 minutes (SD 3 hours) in group II (P=.0067). The rate of hospitalization was 40% in group I and 82% in group II. At 30 days, the mortality was significantly higher in older persons (1% versus 9%, P<.001). Conclusion: Older patients have a proper CAP profile, but the clinical management was similar to that of a young patient. Older patients have a higher mortality rate than young patients. It is necessary to reinforce measures to prevent CAP in older people.