Background:Despiteitsrecommendation in managementguidelinesforcommunity acquiredpneumonia (CAP), the CURB65 score isfrequently not followedfordispositiondecisions in
clinicalroutine. Wethereforeproposed an improved
CURB65 A score, supplementedbyproadrenomedullin (ProADM)
levelsforpatientswith CAP andotherlowerrespiratorytractinfections
(LRTIs). In thisstudy, wevalidatedthisrisk basedbiomarker enhanceddisposition in patientswith LRTIs
presentingtotheemergencydepartmentofthe University Hospital
of Basel.Methods: In this prospective observational cohort study
of 85 patients presenting with LRTIs, site of care was decided by the
physicians in charge according to their judgement. Retrospectively the CURB65 A score was
calculated and a virtual disposition assigned. This was compared with the
existing disposition in order to identify efficacy of the novel risk based
biomarker enhanced disposition.Results: The novel disposition criteria considered 14
patients suitable for outpatient treatment compared to 11 in the current disposition (p=0.5). It detected 7 patients to be
best treated outside the hospital for nursing reasons, while the current
disposition detected only 1 patient requiring geriatric care (p=0.09). Further, it decreased regular
hospitalizations considerably (32 vs. 64, p<0.001).Conclusions: The novel
risk based biomarker enhanced disposition is an objective, safe and probably
more efficient disposition system to identify outpatient treatment options than
the current practice at the University Hospital of Basel.
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