Management and documentation of pneumonia – a comparison of patients consulting primary care and emergency care

Abstract

Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia.

Objective

To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral.

Design

Medical record review of vital signs, examination findings and severity of pneumonia.

Setting

Primary and emergency care.

Subjects

Two hundred and forty patients diagnosed with pneumonia.

Main outcome measures

Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65.

Results

Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection.

Conclusions

Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.

Key Points

• Pneumonia patients attending primary care have less affected vital signs than those attending emergency care.

• Vital signs were less documented in primary care than in emergency care.

• Patients with pneumonia seem to attend the correct level of care when they have the possibility to choose without a referral.

• CRB-65 was not possible to count in most primary care patients due to lack of documentation.

Keywords:

• Pneumonia
• primary care
• emergency care
• vital signs
• severity scoring

Acknowledgements

We extend our sincere appreciation to the patients whose medical records were reviewed for this study.

Ethical approval

This study was approved by the Swedish Ethical Review Authority (Dnr. 2021/02218).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated and analyzed during the current study are not publicly available due to Swedish legislation (the Personal Data Act) but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Medical Research Council of Southeast Sweden: FORSS 968496 and Region Jönköping County.