A Critical Evaluation of Pneumonia Mortality in an Internal medicine Service of the “Padre Américo” Hospital – Vale do Sousa

Abstract

Introduction: Pneumonia is still a serious illness in spite of the use of potent antimicrobials
and effective vaccines. Correct diagnosis and prognostic evaluation are amongst the most
important steps for successful management.
Goals/ Methods: In this study 126 deaths in patients, in whom the main diagnosis was pneumonia, were characterized. The study period was from 1999 to 2001. Clinical, laboratory, radiographic and microbiological data was collected from
the records in clinical files. The adequacy of two
methods of assessing prognosis was also evaluated as well as the quality of physician care.
Statistics were handled using SSPS 11.0.
Results and Discussion: The majority of patients were male and the mean age found was 77.6±11.0 years. The most important adverse prognostic features present in the patients were:
respiratory rate>30/minute, admission diastolic blood pressure<60mmHg, mental confusion,
acidaemia and urea and creatinine plasmatic
levels above 50 and 1.2 mg/dL, respectively. No
pathogen was identified in 60% of the cases. A
significant number of patients were categorised as having a bad prognosis by both methods
applied, making them equally useful in the admission decision process. There was an agreement between the BTS and PORT scales. The initial approach lacked quality in the blood gas
and aetiologic evaluation, in the delay in starting antibiotic therapy and in the low rates of
vaccination. The use of a pneumonia protocol is supported.