What are the criteria for hospital admission in patients with Upper Respiratory Tract Infections (URTI)?

Criteria for Hospital Admission in Upper Respiratory Tract Infections (URTI)

Hospital admission should be considered for patients with URTI who show signs of severe illness, have significant risk factors for complications, or cannot be safely managed at home.

Clinical Signs Requiring Hospital Admission

• Signs of immediate severity:

  • Temperature <35°C or ≥40°C
  • Heart rate ≥125 beats/min
  • Respiratory rate ≥30 breaths/min
  • Cyanosis
  • Blood pressure <90/60 mmHg
  • Confusion or diminished consciousness 1

• Complications requiring admission:

  • Suspected pleural effusion or cavitation
  • Metastatic infection 1
  • Failure to respond to appropriate antibiotic therapy 1

Risk Factors Warranting Hospital Admission

• Age-related factors:

  • Elderly patients (>65 years) with pneumonia and elevated risk of complications 1
  • Patients >65 years with acute cough and two or more risk factors 2
  • Patients >80 years with acute cough and one or more risk factors 2

• Comorbidities increasing admission risk:

  • Diabetes mellitus
  • Heart failure
  • Moderate to severe COPD
  • Liver disease
  • Renal disease
  • Malignant disease
  • Immunocompromised status 1, 3

• Social factors necessitating admission:

  • Home management appears impossible
  • Social exclusion
  • Extreme poverty
  • Dependency
  • Poor likelihood of good compliance
  • Altered mental status 1

Laboratory and Radiological Criteria for Hospital Management

• Blood test abnormalities:

  • Leukopenia (<4,000 WBC/mL) or severe leukocytosis (>20,000 WBC/mL)
  • Anemia (hemoglobin <9 g/100 mL)
  • Renal impairment (serum urea >7 mM or 20 mg/dL, creatinine >1.2 mg/dL)
  • Arterial blood gas abnormalities: PaO₂ <60 mmHg or PaCO₂ >50 mmHg on room air
  • Acidosis (pH <7.3)
  • Coagulation abnormalities suggesting disseminated intravascular coagulation 1

• Radiological findings:

  • Multilobar involvement
  • Pleural effusion
  • Cavitation on chest radiograph 1

Special Considerations for Immunocompromised Patients

• Immunocompromised patients require a lower threshold for admission due to:
  • Higher risk of atypical presentations
  • Increased risk of unusual pathogens
  • Greater potential for rapid deterioration
  • Higher risk of complications including abscess formation or invasion of critical structures 3

Patients Requiring ICU Admission

Hospital admission with ICU consideration is recommended for patients with:

• Severe respiratory failure:

  • Respiratory rate >30 breaths/min
  • PaO₂/FiO₂ <250 mmHg (<200 mmHg if COPD)
  • Need for mechanical ventilation
  • Radiographic spread of pneumonia (increase in size of opacity by ≥50% within 48h of admission) 1

• Severe hemodynamic instability:

  • Systolic blood pressure <90 mmHg or diastolic <60 mmHg
  • Need for vasoactive drugs for more than 4 hours
  • Urine output <20 mL/h (in absence of hypovolemia) 1

• Severe metabolic or hematologic abnormalities:

  • Severe acidosis (pH <7.30)
  • Severe disseminated intravascular coagulation
  • Acute renal failure requiring dialysis 1

Practical Algorithm for Decision-Making

1. Assess for signs of immediate severity (temperature, vital signs, mental status)
2. Evaluate risk factors (age, comorbidities)
3. Consider social factors affecting home management
4. Assess for complications
5. Review laboratory and radiological findings if available

When in doubt, err on the side of caution and consider hospital admission, especially for patients with multiple risk factors or those at the extremes of age 1, 2.