Should the Patient be Hospitalized?
-We recommend based on moderate quality evidence consideration of hospitalization for the following patients:
The PIDS/IDSA guideline offers specific recommendations for hospitalization for children and infants with CAP:
1. Moderate to severe CAP: respiratory distress including tachypnea for age, dyspnea, retractions, grunting, nasal flaring, apnea, altered mental status and/or hypoxemia.
2. Infants less than 3-6 months of age suspected of bacterial pneumonia.
3. Children/infants suspected of pneumonia with Staphylococcus aureus as a pathogen.
4. Children/infants with concerns for compliance with therapy.
Recommendations for admission to the ICU include respiratory failure or impending respiratory failure, need for pharmacologic support of blood pressure or perfusion, patient remains hypoxic on >0.50 inspired O2 or a patient with altered mental status (Bradley, Byington et al. 2011). The British Thoracic Society recommendations for hospitalization include children with CAP that are not responding treatment, are hypoxic and concern for complicated pneumonia based on auscultation in the office setting (Harris, Clark et al. 2011).
These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time.
It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.