Risk Stratification of Adult Pneumonia in a Tertiary Emergency Center in Japan

Objective To determine whether the guidelines for community-acquired pneumonia published by the Infectious Disease Society of America (IDSA) and the Japanese Respiratory Society (JRS) are applicable to stratifying the mortality risk of patients visiting a tertiary emergency center in Japan. Methods Patients were categorized into three risk groups (low, intermediate and high) based on the IDSA guidelines and three severity groups (mild, moderate and severe) using the JRS guidelines. The mortality rates among each set of groups were then compared using 30-day follow-up data. Patients Ninety-seven consecutive patients with pneumonia who visited the emergency room and were admitted to our hospital were retrospectively identified. Results Based on the IDSA guidelines, the patients were categorized into a high, intermediate, or low-risk group (38.1%, 51.5% and 10.3%, respectively). Cumulative mortality rates were 18.9% for the high-risk group and 4.0% for the moderate-risk group (p=0.02); no deaths occurred in the low-risk group. Based on the JRS guidelines, the patients were also classified into a severe, moderate, or the mild-severity group (69.1%, 25.8% and 5.2%, respectively). The mortality rate was 13.4% in the severe group, whereas no deaths occurred in the moderate or mild-severity groups. Conclusion The IDSA and JRS guidelines allow short-term mortality risks to be recognized at a tertiary emergency center in Japan. (Internal Medicine 42: 676-680, 2003)