J Korean Soc Emerg Med.  2020 Apr;31(2):210-220.

Characteristics of the pneumonia patients transferred from long-term care hospitals:retrospective study of one regional emergency medical center

• Kim HI
• Ryu S
• Jeong WJ
• Cho YC
• Ahn HJ
• Cho SW
• Oh SK
• Park JS
• You YH

Abstract

Objective
This study investigated the characteristics of elderly pneumonia patients transferred from long-term care hospitals (LTCH).
Methods
The initial emergency department (ED) data of patients, who were transferred from other hospitals and over 65 years old and hospitalized from 2014 to 2018 for pneumonia management through the ED, were extracted from the electronic medical records. The differences in the initial status and prognosis between the LTCH group and non-LTCH group were compared, and the initial ED variables that affect the in-hospital mortality of the LTCH group were investigated.
Results
The total number of patients was 1,032; 423 (41.0 %) were included in the LTCH group. Compared to the non- LTCH group, the following severity indices, some laboratory data, and mortality were worse in the LTCH group: systemic inflammatory reaction syndrome (SIRS) criteria ≥2 (65.0% vs. 56.7%, P=0.008), quick Sequential Organ Failure Assessment score ≥2 (48.2% vs. 20.4%, P<0.001), CURB-65 (Confusion, Urea nitrogen, Respiration rate, Blood pressure, Age≥65 years) criteria ≥3 (51.8% vs. 29.2%, P<0.001), pneumonia severity index (PSI) class ≥4 (86.5% vs. 61.2%, P<0.001), modified early warning score ≥5 (38.8% vs. 18.4%, P<0.001), serum albumin (median [IQR], 2.6 [2.2- 2.9] g/dL vs. 2.8 [2.4-3.2] g/dL; P<0.001), blood urea nitrogen/albumin (B/A) ratio (median [IQR], 8.0 [5.0-12.8] vs. 6.6 [4.4-10.4]; P<0.001), and in-hospital mortality (26.0% vs. 15.9%, P<0.001). Multivariate regression analysis revealed the albumin grade, B/A ratio grade, PSI class, and SIRS criteria to independently affect the in-hospital mortality of the LTCH group.
Conclusion
The LTCH group had poorer initial severity indices and higher in-hospital mortality than the non-LTCH group. In addition, the albumin grade, B/A ratio grade, could be used for the severity index of pneumonia patients transferred from the LTCH.

Keyword

Pneumonia; Long-term care; Transfer; Prognosis