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

Official 2020 guideline from the American College of Emergency Physicians.

Strength

Treatment

Clinical Decision Aids

Level B

The Pneumonia Severity Index (PSI) and CURB-65 decision aids can support clinical judgment 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

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).

Level C

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).

Level C

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).

Antimicrobial Therapy

Level C

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.

Antibiotic Therapy

Level C

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).

Literature

Original/Primary Reference

Wolf, Stephen J.Smith, Michael D. et al. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community- Acquired Pneumonia Annals of Emergency Medicine, Volume 77, Issue 1, e1 - e57, January 2021

Summary By

Eric Steinberg, DO, MEHP

What do the ratings mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on preliminary, inconclusive, or conflicting evidence, or in the absence of any published literature, based on panel consensus.