Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Publication Date: October 1, 2020
Last Updated: March 14, 2022

Recommendations

In the adult ED patient diagnosed with community acquired pneumonia, what clinical decision aids can inform the determination of patient disposition?
 

The Pneumonia Severity Index (PSI) and CURB-65 decision aids can support clinical judgement by identifying patients at low risk of mortality who may be appropriate for outpatient treatment. Although both decision aids are acceptable, the PSI is supported by a larger body of evidence and is preferred by other society guidelines (ATS/IDSA 2019 guidelines).
(Level B recommendation)
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Among patients not receiving vasopressors or mechanical ventilation, use the 2007 IDSA/ATS Minor Criteria rather than mortality prediction aids such as the PSI or CURB-65 to help establish which patients are most appropriate for care based in an ICU setting
(Consensus recommendation. Level C recommendation.)
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Do not routinely use biomarkers to augment the performance of clinical decision aids to guide the disposition of ED patients with CAP
(Consensus recommendation). Level C recommendation.)
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Use CAP clinical decision aids in conjunction with physician clinical judgment in the context of each patient’s circumstances when making disposition decisions.
(Consensus recommendation) Level C recommendation.)
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In the adult ED patient with community-acquired pneumonia, what biomarkers can be used to direct initial antimicrobial therapy?

Do not rely upon any current laboratory test(s), such as procalcitonin and/or Creactive protein, to distinguish a viral pathogen from a bacterial pathogen when deciding on administration of antimicrobials in ED patients who have CAP.
(Level C recommendations)
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In the adult ED patient diagnosed with community-acquired pneumonia, does a single dose of parenteral antibiotics in the ED followed by oral treatment versus oral treatment alone improve outcomes?

Given the lack of evidence, the decision to administer a single dose of parenteral antibiotics prior to oral therapy should be guided by patient risk profile and preferences.
(Consensus recommendation. Level C recommendation.)
6731

Recommendation Grading

Overview

Title

Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Authoring Organization

Publication Month/Year

October 1, 2020

Last Updated Month/Year

February 6, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D017714 - Community-Acquired Infections, D053717 - Pneumonia, Ventilator-Associated

Keywords

Clinical Guideline, Antimicrobial Therapy, Community Acquired-Pneumonia, acute pulmonary parenchymal infection

Source Citation

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Community-Acquired Pneumonia; Smith MD, Fee C, Mace SE, Maughan B, Perkins JC Jr, Kaji A, Wolf SJ. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia. Ann Emerg Med. 2021 Jan;77(1):e1-e57. doi:10.1016/j.annemergmed.2020.10.024. PMID: 33349374.