Scope of Application This guideline is intended for physicians working in emergency departments who evaluate and treat community-acquired pneumonia. Inclusion Criteria This guideline is intended for adult emergency department patients with community-acquired pneumonia.
Exclusion Criteria This guideline is not intended for pediatric or pregnant patients.
Critical Questions
In the adult emergency department patient diagnosed with community-acquired pneumonia, what clinical decision aids can inform the determination of patient disposition?
Level B Recommendation:
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 Recommendations:
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)
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)
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)
In the adult emergency department patient with community-acquired pneumonia, what biomarkers can be used to direct initial antimicrobial therapy?
Level C Recommendation:
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.
In the adult emergency department patient diagnosed with community-acquired pneumonia, does a single dose of parenteral antibiotics in the emergency department followed by oral treatment versus oral treatment alone improve outcomes?
Level C Recommendation:
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)
Disclaimer Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician's judgment and patient preferences.
