• Samuel M Brown, Jason P Jones, Dominik Aronsky, Barbara E Jones, Michael J Lanspa, and Nathan C Dean.
• Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. samuel.brown@imail.org
• Respirology. 2012 Nov 1;17(8):1207-13.

Background And ObjectiveAppropriate triage of patients with community-acquired pneumonia (CAP) may improve morbidity, mortality and use of hospital resources. Worse outcomes from delayed intensive care unit (ICU) admission have long been suspected but have not been verified.MethodsIn a retrospective study of consecutive patients with CAP admitted from 1996-2006 to the ICUs of a tertiary care hospital, we measured serial severity scores, intensive therapies received, ICU-free days, and 30-day mortality. Primary outcome was mortality. We developed a regression model of mortality with ward triage (and subsequent ICU transfer within 72 h) as the predictor, controlled by propensity for ward triage and radiographic progression.ResultsOf 1059 hospital-admitted patients, 269 (25%) were admitted to the ICU during hospitalization. Of those, 167 were directly admitted to the ICU without current requirement for life support, while 61 (23%) were initially admitted to the hospital ward, 50 of those undergoing ICU transfer within 72 h. Ward triage was associated with increased mortality (OR 2.6, P = 0.056) after propensity adjustment. The effect was less (OR 2.2, P = 0.12) after controlling for radiographic progression. The effect probably increased (OR 4.1, P = 0.07) among patients with ≥ 3 severity predictors at admission.ConclusionsInitial ward triage among patients transferred to the ICU is associated with twofold higher 30-day mortality. This effect is most apparent among patients with ≥ 3 severity predictors at admission and is attenuated by controlling for radiographic progression. Intensive monitoring of ward-admitted patients with CAP seems warranted. Further research is needed to optimize triage in CAP.© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

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