Related Experiment Video
Updated: Sep 11, 2025
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Clinical Instability at Discharge and Post-Discharge Outcomes in Patients with Community-Acquired Pneumonia: An
Yogesh Sharma1,2, Arduino A Mangoni2, Rashmi Shahi2
1Department of Acute and General Medicine, Flinders Medical Centre, Adelaide 5042, Australia.
Abstract:
Background/Objectives: Clinical stability within 24 h prior to discharge is a key metric for safe care transitions in hospitalised patients with community-acquired pneumonia (CAP). However, its association with post-discharge outcomes, particularly readmissions, remains underexplored. This study assessed whether clinical instability before discharge is associated with 30-day mortality, readmissions, or a composite of both in hospitalised CAP patients. Methods: This retrospective cohort study included adults (≥18 years) admitted with CAP to two tertiary Australian hospitals between 1 January 2020 and 31 December 2023. Clinical instability was defined as abnormal vital signs (temperature, heart rate, respiratory rate, blood pressure, or oxygen saturation) within 24 h before discharge. Pneumonia severity was assessed using the CURB-65 score and frailty using the Hospital Frailty Risk Score. Multilevel logistic regression models were used to evaluate associations with outcomes, adjusting for age, sex, comorbidities, frailty, disease severity, microbiological aetiology, antibiotics prescribed during admission, and prior healthcare use. Competing risk regression accounted for death when analysing readmissions. Results: Of 3984 patients, 20.4% had clinical instability within 24 h before discharge. The composite outcome occurred in 21.9% patients, with 15.8% readmitted and 6.1% dying within 30 days. Clinical instability was significantly associated with the composite outcome (adjusted odds ratio [aOR] 1.73, 95% CI 1.42-2.09, p < 0.001), primarily driven by increased mortality risk (aOR 3.70, 95% CI 2.73-5.00, p < 0.001). However, no significant association was found between clinical instability and readmissions (aOR 1.16, 95% CI 0.93-1.44, p > 0.05). Conclusions: Clinical instability within 24 h before discharge predicts worse outcomes in CAP patients, driven by increased mortality risk rather than readmissions.
More Related Videos
11:32Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Pneumonia III: Complications and Assessment
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:29Pneumonia II: Pathophysiology
01:31Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....