Analysis of medical care pitfalls in patients died of community-acquired pneumonia in Krasnodarskiy Krai in 2014

The aim of the study was to analyze pitfalls in the management of patients died of community-acquired pneumonia (CAP) in 2014. Methods. The stage 1 of our study included an analysis of statistical findings according to ICD codes J12–J18 in 2010–2014. A retrospective analysis of 1419 medical records of both outpatients and inpatients died of pneumonia in 2014 was carried out at the stage 2 of our study. Of 1419 registered patients died of pneumonia, 88.4% died of CAP and 11.6 % died of nosocomial pneumonia. Diagnosis of pneumonia was confirmed by autopsy in 86% of cases. Statistical analysis was made using Statistica 7.0 software. Results. Mortality from CAP has grown by 49.4% in 2010–2014 including 11% in working-age population. Mortality rate was extremely different in different areas of Krasnodarskiy Krai; the range was 4.6 to 44.9 per 100,000 of adult population. The proportion of patients died at home in 2010-–2014 increased from 50.1% to 53.4%. The pitfalls of early-stage management of patients with CAP were as follows: 1) national standards were not adhered in 76% of cases; 2) severity of pneumonia was underestimated. Physicians did not use scores for pneumonia severity assessment. Pulse oximetry that is typically used to estimate the respiratory failure severity was not performed. Chest X-ray was made only in 26.6% patients died of pneumonia at home. Inappropriate antibacterial therapy was administered in 68% of cases. Other pitfalls included misdiagnosis of the patient’s severity in admission (78.7%), non-use of pulse oximetry (88.3%), and late admission to ICU (84.7%). Conclusion. Improvement in therapists’ knowledge on pneumonia, close adherence to the national guidelines on management of pneumonia, availability of pulse oximetry and improvement in quality of intensive care of severe pneumonia could reduce mortality from CAP.

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