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- Patients who have been living in a nursing home or other residential facility are of greater concern.
- Elderly patients and infants, particularly infants who are less than 1 month old, are more likely to be admitted.
Other Medical Illnesses. Patients may be considered at greater risk if they have:
- Cancer
- Heart failure
- History of stroke
- Kidney failure
- Liver disease
Findings on a Physical Exam. Concerning findings include:
- Altered mental status (confused, less responsive)
- Appearance of being dehydrated, especially if the person is unable to drink fluids
- Fast breathing (more than 30 breaths per minute)
- Heart rate greater than 120 beats per minute
- Systolic blood pressure less than 90 mmHg
- Temperature greater than 104 °F
Laboratory and X-ray Findings. Laboratory findings that are of concern include:
- Elevated blood sugar
- Fluid in the sac around the lung (on chest x-ray)
- Low oxygen in the blood
- Low sodium levels
- Poor kidney function
- Significant anemia (hematocrit less than 30%)
Patients with very few of these risks often can be discharged with outpatient care only. This determination can often be made with a simple physical examination and history. Sometimes a patient only needs to be hospitalized for 24 hours for observation.
Patients with higher scores on these assessment tests often have many risk factors and usually are hospitalized.
When possible, treatment of community-acquired pneumonia should be started within 4 hours of admission to the emergency room or hospital to reduce the chances of mortality and decrease the amount of time a patient needs to spend in the hospital.
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Review Date: 04/13/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
