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A5511 - A Retrospective Audit on Pneumonia Mortality Rates in Elderly Patients and the Decision of Whether to Escalate to High Dependency Unit at University Hospital Southampton
Author Block: E. Teng, B. McKee, B. G. Marshall; Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Rationale: Pneumonia is the sixth leading cause of death in the UK, and its mortality rate increases at the extremes of age. With aging population, the decision of whether to escalate elderly patients to high dependency unit (HDU) is becoming increasingly pertinent. The primary aim of this audit is to determine factors affecting pneumonia mortality rates to provide physicians with prognostic data for decisions on ceiling of care. Our secondary aim is to compare University Hospital Southampton (UHS) mortality rates with those from the 2014-2015 British Thoracic Society (BTS) community acquired pneumonia audit. Methods: Patients aged 80 to 99 admitted to either the ward or HDU in 2016 with pneumonia were retrospectively identified. Duration of admission, inpatient and 30-day mortality rate from date of discharge were calculated. These data were compared with the BTS audit data from 2014 to 2015. Factors including season, presence of sputum culture and viral swabs, and number of antibiotic resistance in isolated organisms were assessed for their effects on mortality rates. Results: 832 ward and 35 HDU patients met the inclusion criteria. Mean admission duration was 13 days on the ward and 19 days on HDU. Inpatient mortality rates for ward and HDU patients were 29% and 57.1% respectively. Ward patients aged 80-84 had 22.7% mortality rate which increased to 39.7% in those aged 95-99 (p=0.01). HDU patients aged 80-89 had 52% mortality which increased to 75% in those aged 90-99. Mortality was lowest in spring and highest in autumn, ranging from 20% to 90% respectively on HDU. Patients who had viral swabs or sputum cultures requested had lower mortalities. Positive sputum culture with three or more antibiotic resistance saw an increase in mortality rate (p=0.04). In comparison to BTS data, UHS had similar inpatient mortality rate and significantly lower 30-day mortality rate. Conclusions: Our data suggests that pneumonia mortality rate increases with factors including age, season and number of antibiotic resistance in positive sputum cultures. Patient admitted to HDU had much greater overall mortality rate than those who remained on the ward. Using our data, we propose that patients with risk factors including old age, autumn season and sputum culture with three or more antibiotic resistance may be less appropriate for HDU admission due to low chance of survival. This is one of the first audits to examine mortality rates of pneumonia on ward versus HDU in elderly patients.