Cuando una persona con neumonia adquirida en la comunidad debe ser internado?


 
Answer:

The CKS guideline on chest infections in adults contains a substantial section on the management of community acquired pneumonia. Concerning deciding on referral to secondary care or admittance to hospital, CKS recommends using the CRB-65 scoring system:

“Assess the CRB-65 score for all people diagnosed with pneumonia:

One point is awarded for each of the following features:
Confusion — recent.
Respiratory rate 30 breaths/min or greater.
Blood pressure — systolic of 90 mmHg or less or a diastolic of 60 mmHg or less.
65 years of age or older.
For people with a CRB-65 score of 3 or more, arrange urgent admission to hospital.
For people with a CRB-65 score of 2, arrange same-day assessment in secondary care. Secondary care options include short-stay inpatient treatment or hospital-supervised outpatient treatment.
For people with a CRB-65 score of 0 or 1, treatment at home may be appropriate, depending on clinical judgement and available social support.

For people over the age of 50 years who smoke and do not require admission to hospital:

Check for possible underlying lung cancer by:
Assessing clinical features of underlying lung cancer.
Arranging a chest X-ray at the time of presentation.
Arranging a follow-up chest X-ray at 6 weeks if the initial X-ray does not detect an underlying malignancy. For further information see How should I follow-up?
Refer urgently under the 2 week waiting rule if there are any clinical or radiographic features of lung cancer.”

CKS provides the following additional information:

• “The CRB-65 system should not be used to replace clinical judgement in deciding if a person should be admitted. Other factors should also be considered in making the decision. These include:
o The person’s wishes.
o Their social support.
o Pre-existing conditions.
o Pregnancy.
o General frailty.

• Clinical features of underlying lung cancer include:

o Hemoptysis.
o Weight loss.
o Voice hoarseness.
o Finger clubbing.
o Cervical and/or supraclavicular lymphadenopathy.
o Features suggestive of metastasis.
• For further information on assessment and management of people with suspected lung cancer, see the CKS topic on Lung cancer – suspected.” [1]

This section also outlines the evidence supporting these recommendations (please see Basis for Recommendation).
Reference
1. CKS. Chest infections – adult. August 2007. (http://www.cks.library.nhs.uk/chest_infections_adult/)

The NLH Question Answering Service aims to answer questions quickly, it is not a systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. The NLH and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document

Archivo de temas valorados criticamente sobre utilidad de pruebas diagnósticas


Fuente: Pediatria Basada en la Evidencia 

  1. Cardiología pediátrica:
    La radiografía de tórax no es útil para descartar la presencia de cardiopatía en niños asintomáticos que presentan un soplo cardiaco
  2. Gastroenterología pediátrica:
    En niños con un cuadro clínico compatible con enfermedad celiaca, la realización simultánea de anticuerpos antigliadina y antiendomisio con un resultado negativo en ambas pruebas es útil para descartar la presencia de esta enfermedad.
    La detección de antígeno de Helicobacter pylori en heces es un método útil para el diagnóstico de la infección por Helicobacter pylori en niños. Actualizado 21 de septiembre 2003
  3. Salud Mental: aunque es un invento igual publican pruebas sobre el diagnostico??? Pero bueno, este blog intenta no tener sesgos de publicacion.
  4. Utilidad de pruebas diagnósticas en Deficit de Atención e Hiperactividad
  5. Neumología pediátrica:
    Utilidad diagnóstica de la taquipnea para el diagnóstico de neumonía en niños menores de cinco años.

AP al dia: resumenes comentados


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