Use of ATS/IDSA severe pneumonia minor criteria to improve emergency department patient disposition: effect on 30-day mortality and resource utilization

Introduction: The ATS/IDSA severe community acquired pneumonia minor criteria (sCAP) predict mortality and need for intensive care unit (ICU) admission. (AJRCCM 2019 200:7 e45) Though recommended in guidelines, use of sCAP to guide emergency department (ED) physicians with disposition has not been studied. Objectives: Evaluate whether sCAP-based guidance within electronic clinical decision support (ePNa) improves 30-day mortality and decreases inappropriate disposition (≥3 criteria admitted to general ward or Methods: Secondary analysis of 2864 patients admitted to 4 urban hospitals in Utah, USA from 2009-2015 identified by ICD-9 codes for pneumonia with imaging confirmation. Those needing vasopressors or mechanical ventilation on admission were excluded. sCAP guided disposition became available in 2011. Mortality and disposition were adjusted for risk by logistic regression; length of stay (LOS) and cost by linear regression. Results: 30-day mortality was 64/684 (9.3%) vs 205/2180 (9.4%) after sCAP; inappropriate disposition to ICU was 39/684 (5.7%) vs 184/2180 (8.4%). Inappropriate disposition to hospital ward did not change 30/685 (4.4%) vs 95/2180 (4.4%). Adjusted change in composite endpoint was not significant (p=0.136). ePNa use was associated with lower total cost (p=0.015) and shorter LOS (p=0.008). Conclusions: In 4 Utah hospitals, sCAP score within ePNa was not associated with improved 30-day mortality and disposition, and inappropriate disposition to the ICU slightly increased. ePNa use may contribute to decreased cost and shorter LOS.