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Author: Mark Winstanley  / Codes: CP2, ResC7, RP2, RP5, SLO1 / Published: 08/07/2015

So here is a guide to the new NICE pneumonia guidelines that were published in December 2014, I hope you find it useful.

Apart from it being important to keep abreast of new guidelines, pneumonia results in major morbidity and mortality and certainly is a large amount of the presentations through our doors in the emergency department. There are a few things that are new in this document and worth taking a note of to develop your practice.

Firstly I want to mention the consideration of point of care C-Reactive Protein (CRP) testing in the community. Now although this is looking more at GPs and less within the Emergency Department (ED) scope it may have some knock on effects for us in the department and I’m sure will create so interesting debate. My initial thought is could this increase the amount of referrals to the ED department? Something we will have to see in due course. Is this something that may, if successful in the community, work its way into the rapid initial assessments?

So the first addition is that anyone with a Moderate to Severe community acquired pneumonia (CAP) should be getting blood culture and sputum cultures and consideration given to pneumococcal and legionella urinary antigen tests.

Alongside this we should be considering intensive care review for patients with a score of 3 or more on CURB65.

The next change is that low severity CAP on the CURB65 score should receive an initial five-day course, rather than seven, with safety netting.

Following on from this the guidance makes some recommendations regarding discharge. They advise that you should not routinely discharge patients if they have had two or more of the following over the last 24 hours:

  • Temperature higher than 37.5°C
  • Respiratory rate 24 breaths per minute or more
  • Heart rate more than 100 beats per minute
  • Systolic blood pressure 90 mm Hg or less
  • Oxygen saturation less than 90% on room air
  • Abnormal mental status
  • Inability to eat without assistance.

A stand-alone point is that if there temperature is higher than 37.5 degrees then you should consider as to whether or not discharge is appropriate, and to consider delaying it.

References

  1. National Institute for Health and Care Excellence. Pneumonia (including community acquired pneumonia). 2014. www.nice.org.uk/guidance/cg191.

Eccles S, Pincus C, Higgins B, Woodhead M, Guideline Development Group. Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance. BMJ. 2014 Dec 3; 349:g6722.