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Clinical Characteristics of Acutely Hospitalized Adults With Community-acquired- Pneumonia

15 september 2022 uppdaterad av: University of Southern Denmark

Clinical Characteristics of Hospitalized Adults With Community-acquired- Pneumonia at the Emergency Department: A Cross-sectional Study

There is no gold standard when diagnosing of pneumonia. The variability of clinical signs and symptoms make it difficult to distinguish pneumonia from other causes of respiratory conditions. Well defined characteristics upon arrival to the emergency department will contribute to the better and quicker diagnosis of community-acquired pneumonia.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Currently, pneumonia diagnosis is primarily based on clinical symptoms such as cough, shortness of breath, chest pain, fever and sputum production, combined with X-ray of the lungs, relevant blood tests and microbiological analysis of sputum samples. The X-ray is an imprecise diagnostic tool, and results from sputum assays are first available after 2 days. In the elderly, pneumonia presents with clinically differing signs such as delirium, malnutrition, and there may be an absence of fever, cough and dyspnea. The physical examination is also challenged by a broad variety of atypical symptoms like headache, dry cough and gastrointestinal symptoms in the form of nausea, vomiting or diarrhea. Our hypothesis is that well-defined clinical characteristics upon arrival to the emergency department will contribute to the better and quicker diagnosis of pneumonia.

The aim is to identify the information available upon arrival to the Emergency Department that contributes to diagnosis and prognosis of community-acquired-pneumonia.

The objectives are:

  1. Identify the information available upon arrival that correlates to the diagnosis of community-acquired pneumonia
  2. Identify the information available upon arrival that correlates to severity of community-acquired pneumonia

Studietyp

Observationell

Inskrivning (Faktisk)

966

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Danmark
      • Aabenraa, Danmark
        • Hospital of Southern Jutland

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Testmetod

Sannolikhetsprov

Studera befolkning

Acutely admitted patients suspected of community-acquired pneumonia at three hospitals in The Region of Southern Denmark (Hospital Sønderjylland, Hospital Lillebaelt and Odense University Hospital).

Beskrivning

Inclusion Criteria:

  • Patients > 18 years old
  • Patients suspected with CAP by the attending physician. The physician will base his/her suspicion on e.g. clinical symptoms such as cough, increased sputum production, chest tights, dyspnea and fever>38C, and indication for x-ray.

Exclusion Criteria:

  • If the attending physician considers that participation will delay a life-saving treatment or patient needs direct transfer to the intensive care unit.
  • Admission within the last 14 days
  • Verified COVID-19 disease within 14 days before admission
  • Pregnant women
  • Severe immunodeficiencies: Primary immunodeficiencies and secondary immunodeficiencies (HIV positive CD4 <200, Patients receiving immunosuppressive treatment (ATC L04A), Corticosteroid treatment (>20 mg/day prednisone or equivalent for >14 days within the last 30 days), Chemotherapy within 30 days)

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Observationsmodeller: Kohort
  • Tidsperspektiv: Tvärsnitt

Kohorter och interventioner

Grupp / Kohort
Intervention / Behandling
Suspected pneumonia diagnosis
Acutely admitted patients suspected having pneumonia.
Övrig: Clinical Assessment within 4 hours of admission
Demographics, Symptoms, Severity scores (Triage at admission, confusion, urea, respiration, blood pressure, age (CURB 65) and pneumonia severity score (PSI), clinical parameters, blood testing, chest x-rays, comorbidities, electro-cardiogram

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Diagnosis of community acquired pneumonia
Tidsram: expert assessment within 3 months after patient discharge from the hospital

The percentage of patients diagnosed with community-acquired pneumonia determined by an expert panel. This outcome measure is a binary variable - verified pneumonia or no pneumonia.

The expert panel consists of two independent consultants from the emergency department with experience in infection and emergency medicine, who individually will determine whether or not the patient admitted with suspected community-acquired pneumonia had the diagnosis. The diagnosis will be based on all available relevant information from the patient medical record within 48 hours from admission including computed tomography. A standardized template will be used. Disagreement will be discussed until a consensus is reached.
expert assessment within 3 months after patient discharge from the hospital

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Intensive care unit (ICU) treatment:
Tidsram: within 60 days from admission to the emergency department
Transfer to the intensive care unit will be recorded during the current hospitalization as a binary variable (transferred/not-transferred)
within 60 days from admission to the emergency department
Length of hospital stay
Tidsram: within 60 days from current admission to the emergency department
Defined as the time (in days) spent in hospital during the current admission. Measured in days from admission to hospital discharge. Discharge date minus admission date
within 60 days from current admission to the emergency department
30 dagars dödlighet
Tidsram: 30 dagar från inläggningen på akutmottagningen
Dödlighet inom 30 dagar från intagning på akutmottagningen
30 dagar från inläggningen på akutmottagningen
Återintagande
Tidsram: inom 30 dagar från utskrivningen till sjukhuset
Om en försöksperson läggs in under en 30-dagarsperiod efter den aktuella sjukhusskrivningen mätt som ett binärt utfall Återinläggning/ej återinläggning.
inom 30 dagar från utskrivningen till sjukhuset
Dödlighet på sjukhus
Tidsram: inom 60 dagar från intagning på akutmottagningen
Patientdödlighet under pågående sjukhusvistelse. Binärt utfall - Död/ Inte död
inom 60 dagar från intagning på akutmottagningen

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
90 days mortality
Tidsram: within 90 days from admission to emergency department
binary
within 90 days from admission to emergency department
CURB-65 score for predicting mortality in community-acquired-pneumonia
Tidsram: within 4 hours from admission
CURB-65 score consists of: Confusion of new onset, Blood Urea nitrogen greater than 7 mmol/L (19 mg/dL), respiratory rate of 30 breaths per minute or greater, blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less and age 65 or older. The score stratify patients to groups 1 (mild pneumonia), 2 (moderate pneumonia) and 3-5 (severe pneumonia).
within 4 hours from admission
Pneumonia severity index (PSI)
Tidsram: : within 4 hours from admission
Risk classes to predict the severity of pneumonia. Scores are given based on demographics, comorbidity, clinical measurements and physical Exam Findings (<70 = Risk Class II, 71-90 = Risk Class III, 91-130 = Risk Class IV, >130 = Risk Class V)
: within 4 hours from admission
Microbial agents
Tidsram: results within 7 days from sputum sample collection
Microbial agents (bacteria and viruses) identified in standard culture, PCR and multiplex PCR. Sputum samples are collected within 1 hour from patient admission. Descriptive findings in percentage will be registered.
results within 7 days from sputum sample collection
Level of infection markers
Tidsram: results within 4 hour from admission
Concentration of serum PCT and suPAR are collected in connection to routine blood tests within 1 hour from admission.
results within 4 hour from admission
Level of markers of lung injury
Tidsram: within 4 hours from admission
Concentration of serum surfactant protein D, KL-6 and YKL-40
within 4 hours from admission
Bacteriuria
Tidsram: within 4 hours from admission
Binary outcome defined by the microbiologist on urine culture analysis
within 4 hours from admission

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Southern Denmark

Utredare

  • Studiestol: Christian Backer Mogensen, University Hospital of Southern Denmark

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

1 mars 2021

Primärt slutförande (Faktisk)

28 februari 2022

Avslutad studie (Faktisk)

1 juni 2022

Studieregistreringsdatum

Först inskickad

23 november 2020

Först inskickad som uppfyllde QC-kriterierna

22 december 2020

Första postat (Faktisk)

23 december 2020

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

16 september 2022

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

15 september 2022

Senast verifierad

1 september 2022

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • SHS-ED-11e-2020

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