Consistent with published guidelines, CAP was defined as an acute illness (< 14 days of symptoms) in which the presence of a new chest radiographic infiltrate was confirmed by either a radiologist or a pulmonary/critical care physician, and having clinical features suggestive of acute pneumonia. The clinical features required for diagnosis were one feature from group A (fever [temperature of > 37.8°C], hypothermia [temperature of < 36°C], cough, and sputum production), or two features from group B (dyspnea, pleuritic pain, physical findings of lung consolidation, and leukocyte count of > 12 X 10 cells/L or < 4.5 X 10 cells/L).
Exclusion criteria included patients with HIV infection, those receiving chemotherapy or who had received immunosuppressive therapy in the past 60 days (including prednisolone, > 20mg/d for > 7 days), nonambulatory nursing home residents, and patients who have been hospitalized within the past 30 days. more
The TFAD was defined as the time difference between the recorded time on presentation to triage in the emergency department and the recorded time of administration of the first dose of antibiotics by the nursing staff. Pneumonia severity index (PSI) scores were calculated at the time of the patient’s admission to the hospital. Septic shock was defined using American College of Chest Physicians/Society of Critical Care Medicine criteria. Hypoxia was defined as an oxygen saturation of < 90% while breathing room air. An altered mental state was defined as any disorientation in time, place, or person including any Glasgow coma scale score of < 15.
Logistic regression analysis was used to assess the impact of clinical factors on TFAD. Significant interactions were included in all models at a threshold of p < 0.1. Analysis was performed using a statistical software package (SPSS, version 11.5.0; SPPS Inc; Chicago, IL). A p value of < 0.05 was considered to be significant. A total of 451 patients were enrolled into the study. The cohort had a mean (±SD) age of 58.2 ± 19.2 years, 53.3% were women, and the severity breakdown by PSI grade was as follows: grade I, 11.3%; grade II, 22.2%; grade III, 18.9%; grade IV, 20.4%; and grade V, 8.7%. The mean TFAD was 285 ± 202 min, with 50.7% of patients not receiving their first dose within 4 h. Of those patients with a TFAD of < 4 h, 32.0% were given antibiotics within 2 h of presentation. Death occurred in 36 patients (8.0%).