ACEP ID:

Community-Acquired Pneumonia (Oct 2020)

Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia

Scope of Application

This guideline is intended for physicians working in emergency departments who evaluate and treat community-acquired pneumonia.

Inclusion Criteria

This guideline is intended for adult emergency department patients with community-acquired pneumonia.

Exclusion Criteria

This guideline is not intended for pediatric or pregnant patients.

 

Critical Questions

  • In the adult emergency department patient diagnosed with community-acquired pneumonia, what clinical decision aids can inform the determination of patient disposition?

    Recommendations
    Level A Recommendations
    None specified.
    Level B Recommendations

    The Pneumonia Severity Index (PSI) and CURB-65 decision aids can support clinical judgement by identifying patients at low risk of mortality who may be appropriate for outpatient treatment. Although both decision aids are acceptable, the PSI is supported by a larger body of evidence and is preferred by other society guidelines (ATS/IDSA 2019 guidelines).

    Level C Recommendations

    Among patients not receiving vasopressors or mechanical ventilation, use the 2007 IDSA/ATS Minor Criteria rather than mortality prediction aids such as the PSI or CURB-65 to help establish which patients are most appropriate for care based in an ICU setting (Consensus recommendation).

    Do not routinely use biomarkers to augment the performance of clinical decision aids to guide the disposition of emergency department patients with community-acquired pneumonia (Consensus recommendation).

    Use community-acquired pneumonia clinical decision aids in conjunction with physician clinical judgment in the context of each patient’s circumstances when making disposition decisions (Consensus recommendation).

    Level A Recommendations
    None specified.
    Level B Recommendations

    The Pneumonia Severity Index (PSI) and CURB-65 decision aids can support clinical judgement by identifying patients at low risk of mortality who may be appropriate for outpatient treatment. Although both decision aids are acceptable, the PSI is supported by a larger body of evidence and is preferred by other society guidelines (ATS/IDSA 2019 guidelines).

    Level C Recommendations

    Among patients not receiving vasopressors or mechanical ventilation, use the 2007 IDSA/ATS Minor Criteria rather than mortality prediction aids such as the PSI or CURB-65 to help establish which patients are most appropriate for care based in an ICU setting (Consensus recommendation).

    Do not routinely use biomarkers to augment the performance of clinical decision aids to guide the disposition of emergency department patients with community-acquired pneumonia (Consensus recommendation).

    Use community-acquired pneumonia clinical decision aids in conjunction with physician clinical judgment in the context of each patient’s circumstances when making disposition decisions (Consensus recommendation).

  • In the adult emergency department patient with community-acquired pneumonia, what biomarkers can be used to direct initial antimicrobial therapy?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Do not rely upon any current laboratory test(s), such as procalcitonin and/or C-reactive protein, to distinguish a viral pathogen from a bacterial pathogen when deciding on administration of antimicrobials in emergency department patients who have community-acquired pneumonia.

    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Do not rely upon any current laboratory test(s), such as procalcitonin and/or C-reactive protein, to distinguish a viral pathogen from a bacterial pathogen when deciding on administration of antimicrobials in emergency department patients who have community-acquired pneumonia.

  • In the adult emergency department patient diagnosed with community-acquired pneumonia, does a single dose of parenteral antibiotics in the emergency department followed by oral treatment versus oral treatment alone improve outcomes?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Given the lack of evidence, the decision to administer a single dose of parenteral antibiotics prior to oral therapy should be guided by patient risk profile and preferences (Consensus recommendation).

    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Given the lack of evidence, the decision to administer a single dose of parenteral antibiotics prior to oral therapy should be guided by patient risk profile and preferences (Consensus recommendation).

Download the Policy

PDF Icon cp-Pneumonia.pdf October 2020

Findings and Strength of Recommendations

Clinical findings and strength of recommendations regarding patient management were made according to the following criteria:
Level A recommendations
Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).
Level B recommendations
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
Level C recommendations
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude, and publication bias, among others, might lead to a downgrading of recommendations.
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