Pneumonia severity scores and prescribing antibiotics for community-acquired pneumonia at an Australian hospital

Aim: To evaluate the use of pneumonia severity scores for diagnosing community-acquired pneumonia (CAP) and to assess whether antibiotic prescribing was compliant with guidelines as determined by the calculated pneumonia severity score. Method: A retrospective chart review was undertaken of consecutive adults admitted via the emergency department with a diagnosis of CAP during a 6-month period. Charts were reviewed for symptoms and radiographic evidence of pneumonia and for recorded pneumonia severity scores. Pneumonia severity scores were calculated using CORB, CURB-65 and SMART-COP for patients with available data and used to assess compliance with the Therapeutic Guidelines: Antibiotic. Results: Of the 204 patients reviewed, 69 had radiographic evidence and symptoms of CAP. Only 1 patient had a pneumonia severity score recorded. Based on calculated CORB, CURB-65 and SMART-COP scores for the remaining 68 patients, 13 (19%), 3 (4.4%) and 1 (3.6%) patients had severe pneumonia. 93% of patients received ceftriaxone. An average of 8% of patients were prescribed antibiotics compliant with the Therapeutic Guidelines: Antibiotic. Compliance varied with the pneumonia severity scoring tool used. Conclusion: Pneumonia severity scores were rarely calculated to guide treatment and antibiotic prescribing for CAP. Compliance with the Therapeutic Guidelines: Antibiotic was poor and varied with the pneumonia severity scoring tool used. An easy-to-use pneumonia severity score to guide patient admission and choice of antibiotic is needed.