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Clinical Decision Tool Shows Promise in Reducing Pneumonia Deaths

October 7th, 2016

SALT LAKE CITY – Use of an advanced clinical decision tool potentially could reduce mortality for the 1.1 million patients treated for pneumonia in the United States each year.

That’s according to a new study, published recently in Annals of Emergency Medicine.

Researchers from Intermountain Medical Center in Salt Lake City report that a tool they developed saved up to 12 lives in hospitals where it was used, compared to routine care standards. Currently, more than 50,000 Americans die each year from pneumonia.

According to the report, the advanced computer program combines a patient's personal medical information and risk factors in real time to alert emergency department physicians to the possibility of a pneumonia diagnosis.

Once pneumonia is confirmed by the physician, the tool automatically provides a calculated severity assessment as well as management recommendations, which include diagnostic testing and antibiotic selection, based on current North American pneumonia treatment guidelines.

"Because of the complexity of pneumonia, physicians can't easily make consistent decisions that follow current treatment recommendations," explained lead author Nathan Dean, MD, a pulmonologist and chief of critical care medicine at Intermountain Medical Center.

In the prospective, controlled trial in seven Intermountain Healthcare hospital EDs in urban areas in Utah, the researchers looked at patients diagnosed with pneumonia from December 2009 through November 2010, prior to introduction of the tool, and December 2011 through November 2012, after the tool was deployed.

The study compared 30-day, all-cause mortality adjusted for illness severity at the four intervention EDs, which began using the tool in May 2011, to three EDs providing usual care.

Of 4,758 ED pneumonia patients, 14% of whom had healthcare-associated pneumonia, median age was 58, 53% were female and 59% were admitted to the hospital.

With the tool used in 62.6% of intervention ED study patients, no difference was detected in severity-adjusted mortality between intervention and usual care EDs’ post–tool deployment. Post hoc analysis, however, indicated that patients with community-acquired pneumonia experienced significantly lower mortality, whereas mortality was unchanged among patients with healthcare–associated pneumonia. Tool recommendations were followed more by patients discharged from EDs post-deployment, according to the researchers.

"This tool doesn't take over for doctors, but it does assemble the needed information, calculates the patients' severity of illness and likelihood of infection with resistant bacteria, and presents recommendations to help doctors make better decisions,” Dean said. “It's all about giving local doctors tools to be more consistent, objective, and focused on best practices."