Determinants for hospitalization in " low-risk" XXXX .

@entity1 @entity8 @entity55 @entity645 @entity7405 @entity591 @entity497 @entity551
BACKGROUND: A variable decision in managing @entity497 ( @entity497 ) is the initial site of care; in- @entity1 versus outpatient. These variations persist despite comprehensive practice guidelines. @entity1 with a @entity55 Severity Index (PSI) score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These @entity1 are generally below the age of fifty years, non-nursing home residents, @entity645 negative and have no major @entity8 . METHODS: A retrospective analysis of 296 low-risk @entity497 @entity1 evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All @entity1 were assigned a PSI score. 208 (70%) were evaluated and discharged from the emergency department (E.D.) to complete outpatient antibiotic therapy, while 88 (30%) were hospitalized. @entity1 were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. RESULTS: Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018), African Americans (CI: 0.31-0.73, p= 0.004), insurance coverage (CI: 0.19-0.63, p= 0.0034), temperature (CI: 0.04-0.09, p= 0.0001) and pulse rate (CI: 0.03-0.14, p= 0.0001). No statistically significant differences were observed between the two groups for altered mental status, @entity551 , @entity7405 , laboratory/radiological parameters and social indicators (p>0.05). The average length of stay for in- @entity1 was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk @entity497 @entity1 by admitting physicians was less than optimal. CONCLUSIONS: High fever, @entity591 , female gender, African- American race and medical insurance coverage are determinants for hospitalization among low risk @entity497 @entity1 in our study. The average length of stay for in- @entity1 was 3.5 days (3 to 5 days). The cost of in- @entity1 care was about eight times higher than outpatient management. This study supports the recommendation of using the PSI for E.D evaluation of @entity1 in appropriate social settings.
