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Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. Appropriate management of CAP includes accurate assessment of disease severity at the time of admission, to indicate the optimal intervention. This clinical audit aimed to evaluate the severity assessment and management of patients who presented with CAP to the emergency department at Nasser Hospital, Khan Younis, Gaza Strip, occupied Palestinian territory. A retrospective study was conducted of the 100 patients (aged 18-88 years) admitted to Nasser Hospital with CAP between November, 2017, and April, 2018, who met inclusion criteria and gave consent, and for whom we could retrieve data. Patients with hospital-acquired pneumonia, aspiration pneumonia, and exacerbation of chronic obstructive pulmonary disease or asthma by infection were excluded from the study. The audit standards were based on the Nasser Hospital local protocol, which is adapted from the guidelines of the Infectious Diseases Society of America and American Thoracic Society on the management of CAP in adults (March, 2007). SPSS Statistics (v.23.0) was used for data management and statistical analysis. We obtained verbal patient consent, and ethical approval was obtained from the Ministry of Health. The mean age of patients was 57 years (SD 20·4). 49 (49%) patients were male and 51 (51%) were female. Respiratory rate and oxygen saturation were documented for 11 (11%) and 57 (57%) patients, respectively. Blood urea nitrogen level was analysed for all patients. All of the variables of the CURB-65 score were documented for 11 patients (11%), whereas four of five variables were documented for 72 patients (72%). The respiratory rate was the least documented variable (11%). Microbiological diagnosis (blood and sputum culture) was done for six patients (6%). Patients received a combination of one of the third-generation cephalosporins (ceftriaxone, cefotaxime, ceftazidime; 100% of patients) plus azithromycin (89%), doxycycline (5%), trovafloxacin (3%), or gentamicin (3%). In total, 94 patients (94%) were prescribed both the recommended antibiotics and the appropriate dose and duration. None of the patients received the first dose of antibiotics during their stay in the emergency department. 66 patients (66%) received corticosteroids (31 received intramuscular dexamethasone 4 mg, 27 received oral prednisone 20 mg, and 8 received intravenous hydrocortisone 100 mg). There was poor adherence to the CURB-65 score system, despite its benefits in terms of assessment and classification of CAP severity. We also found evidence of inappropriate prescription of corticosteroids, which are recommended for severe pneumonia only. Furthermore, there was no administration of the initial dose of antibiotic in the emergency department, despite its association with lower mortality. More successful implementation of the guidelines will require regular re-auditing and continuing medical education. None. Copyright © 2022 Elsevier Ltd. All rights reserved.


Hamza Yazji, MohammedSaeb Al-Jadba, Mohammed Sammour, Mohammed Alkhatib, Alaa-Eldeen Elmassry. Severity assessment and management of community-acquired pneumonia: a retrospective clinical audit. Lancet (London, England). 2022 Jun;399 Suppl 1:S29

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PMID: 35786264

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