From the Guidelines
Hospitalization for patients with community-acquired pneumonia (CAP) should be considered based on the presence of risk factors, including age over 65 years, coexisting illnesses, and certain physical and laboratory findings, as outlined in the guidelines 1. When determining the need for hospitalization, several factors should be taken into account, including:
- Age over 65 years
- Presence of coexisting illnesses such as chronic obstructive lung disease, bronchiectasis, malignancy, diabetes mellitus, chronic renal failure, congestive heart failure, chronic liver disease, chronic alcohol abuse, malnutrition, cerebrovascular disease, and postsplenectomy
- Certain physical findings, including a respiratory rate of 30 breaths/min, diastolic blood pressure of 60 mm Hg or systolic blood pressure of 90 mm Hg, pulse of 125/min, fever of 35 or 40 C, confusion or decreased level of consciousness, and evidence of extrapulmonary sites of infection
- Laboratory findings, including a white blood cell count of 4 109/L or an absolute neutrophil count below 1 109/L, Pa O2 of 60 mm Hg or Pa CO2 of 50 mm Hg while breathing room air, evidence of abnormal renal function, and presence of certain unfavorable chest radiograph findings. The decision to hospitalize should also consider social factors, such as the absence of a responsible caregiver in a stable home situation, and the availability of outpatient support services, as noted in the guidelines 1. In contrast to the guidelines for skin and soft tissue infections, which recommend hospitalization for patients with severe or necrotizing infections, or those with poor adherence to therapy 1, the guidelines for CAP emphasize the importance of considering the overall clinical picture and the presence of risk factors when determining the need for hospitalization. The most recent and highest quality study on this topic is from 2001 1, which provides a comprehensive outline of the risk factors and guidelines for hospitalization in patients with CAP.
From the Research
Guidelines for Capping Hospitalization
There are no specific guidelines for capping hospitalization mentioned in the provided studies. However, the studies discuss the importance of evidence-based guidelines for preventing venous thromboembolism (VTE) in hospitalized patients 2, 3, 4, 5, 6.
Venous Thromboembolism Prophylaxis
The studies suggest that enoxaparin and unfractionated heparin (UFH) are effective for VTE prophylaxis in hospitalized patients 4, 5, 6. However, the choice between enoxaparin and UFH depends on various factors, including patient characteristics and renal function 5.
Key Principles of Clinical Practice Guidelines
The development of clinical practice guidelines (CPGs) should follow key principles, including:
- Bias minimization
- Systematic evidence retrieval and review
- Focus on patient-relevant outcomes 3 CPGs should be developed, disseminated, and evaluated to ensure that they are effective in improving patient outcomes and reducing healthcare costs 3.
Comparative Effectiveness of Enoxaparin and UFH
Studies have compared the effectiveness of enoxaparin and UFH for VTE prophylaxis in hospitalized patients. The results suggest that enoxaparin may be associated with reduced odds of VTE, in-hospital mortality, and major bleeding compared to UFH 4, 6. However, the choice between enoxaparin and UFH should be based on individual patient characteristics and clinical judgment 5.