J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 4, Number 5, October 2012, pages 338-345

Emergency Department Pneumonia Patients Who do not Meet the Six-Hour Criteria for Antibiotic Administration: Do They Have a Different Clinical Presentation?/b>

**Table 1.** Univariate Analysis Comparing Characteristics of Cases That Met and Failed to Meet the Joint Commission Six-Hour Standard for Antibiotic Administration
Variable	Met criteria (n = 277)	Failed to meet criteria (n = 86)	P value
Age (mean ± SD)	63.2 ± 18.7	60.9 ± 17.3	0.32
Female, %	49	52	0.62
Triage vital signs (mean ± SD)
Pulse	111 ± 22	104 ± 17	0.007
Systolic BP	140 ± 31	141 ± 27	0.76
Respiratory rate	25 ± 9	22 ± 6	0.002
Temperature	99.9 ± 2.2	99.6 ± 1.9	0.22
Oxygen saturation	87 ± 10	92 ± 5	< 0.001
Nursing home resident, %	2.9	1.2	0.69
Altered mental status present, %	12.6	5.8	0.11
Co-morbidities, %
History of liver disease	4.7	5.8	0.78
History of CHF	6.1	4.7	0.79
History of cardiovascular accident	9.8	9.3	1.0
History of renal disease	5.0	1.2	0.21
History of cancer	9.4	7.0	0.66
Chief complaint at triage, %
Fever	22.0	24.4	0.66
Dyspnea	40.8	29.1	0.06
Cough	39.7	34.9	0.45
Chest pain	22.7	23.3	1.0
Weakness/fatigue	11.9	12.8	0.85
Abdominal pain	3.3	7.0	0.13
Chief complaint to doctor, %
Fever	45.1	40.7	0.54
Dyspnea	48.7	43.0	0.39
Cough	61.0	64.0	0.70
Chest pain	31.8	32.6	0.90
Weakness/fatigue	11.6	10.5	0.85
Abdominal pain	7.6	7.0	1.0
Day of week, %
Sunday	10.1	8.1	0.21
Monday	15.9	17.4
Tuesday	14.4	23.3
Wednesday	15.2	15.1
Thursday	19.9	9.3
Friday	13.4	12.8
Saturday	11.2	14.0
Time of day, %
Early (7:00 - 14:59)	42.2	41.9	0.05
Mid-day (15:00 - 22:59)	36.8	47.7
Night (23:00 - 6:59)	20.9	10.5

Table 1. Univariate Analysis Comparing Characteristics of Cases That Met and Failed to Meet the Joint Commission Six-Hour Standard for Antibiotic Administration

Variable

Met criteria
(n = 277)

Failed to meet criteria
(n = 86)

P value

Age (mean ± SD)

63.2 ± 18.7

60.9 ± 17.3

0.32

Female, %

0.62

Triage vital signs (mean ± SD)

Pulse

111 ± 22

104 ± 17

0.007

Systolic BP

140 ± 31

141 ± 27

0.76

Respiratory rate

25 ± 9

22 ± 6

0.002

Temperature

99.9 ± 2.2

99.6 ± 1.9

0.22

Oxygen saturation

87 ± 10

92 ± 5

< 0.001

Nursing home resident, %

2.9

1.2

0.69

Altered mental status present, %

12.6

5.8

0.11

Co-morbidities, %

History of liver disease

4.7

5.8

0.78

History of CHF

6.1

4.7

0.79

History of cardiovascular accident

9.8

9.3

1.0

History of renal disease

5.0

1.2

0.21

History of cancer

9.4

7.0

0.66

Chief complaint at triage, %

Fever

22.0

24.4

0.66

Dyspnea

40.8

29.1

0.06

Cough

39.7

34.9

0.45

Chest pain

22.7

23.3

1.0

Weakness/fatigue

11.9

12.8

0.85

Abdominal pain

3.3

7.0

0.13

Chief complaint to doctor, %

Fever

45.1

40.7

0.54

Dyspnea

48.7

43.0

0.39

Cough

61.0

64.0

0.70

Chest pain

31.8

32.6

0.90

Weakness/fatigue

11.6

10.5

0.85

Abdominal pain

7.6

7.0

1.0

Day of week, %

Sunday

10.1

8.1

0.21

Monday

15.9

17.4

Tuesday

14.4

23.3

Wednesday

15.2

15.1

Thursday

19.9

9.3

Friday

13.4

12.8

Saturday

11.2

14.0

Time of day, %

Early (7:00 - 14:59)

42.2

41.9

0.05

Mid-day (15:00 - 22:59)

36.8

47.7

Night (23:00 - 6:59)

20.9

10.5

**Table 2.** Results of Multiple Logistic Regression Using Stepwise Variable Selection to Identify Patient Risk Factors Associated With Likelihood to Meet Joint Commission Criteria for Administration of Antibiotics Within Six Hours if Diagnosed With CAP in the ED
Risk factors	Odds ratio	(95% CI)	P value
Pulse rate	1.02	1.00 - 1.03	0.010
Oxygen saturation	0.90	0.85 - 0.95	< 0.001
Altered mental status present	3.63	1.14 - 11.51	0.029
Presentation 3PM-11PM	0.35	0.14 - 0.89	0.027
Presentation on Thursday	2.83	1.16 - 6.91	0.023

Table 2. Results of Multiple Logistic Regression Using Stepwise Variable Selection to Identify Patient Risk Factors Associated With Likelihood to Meet Joint Commission Criteria for Administration of Antibiotics Within Six Hours if Diagnosed With CAP in the ED

Risk factors

Odds ratio

(95% CI)

P value

Pulse rate

1.02

1.00 - 1.03

0.010

Oxygen saturation

0.90

0.85 - 0.95

< 0.001

Altered mental status present

3.63

1.14 - 11.51

0.029

Presentation 3PM-11PM

0.35

0.14 - 0.89

0.027

Presentation on Thursday

2.83

1.16 - 6.91

0.023

**Table 3.** Characteristics of Cases Included in Multiple Logistic Regression Compared to Cases not Included due to Incomplete Antibiotic Data
Variable	Cases with complete antibiotic data (n = 363)	Cases with incomplete antibiotic data (n = 131)	P value
Age (mean ± SD)	62.7 ± 18.4	61 ± 17.5	0.37
Female, %	50	47	0.68
Triage vital signs (mean ± SD)
Pulse	109 ± 21	104 ± 20	0.008
Systolic BP	140 ± 30	143 ± 27	0.45
Respiratory rate	24 ± 8	23 ± 6	0.19
Temperature	99.8 ± 2.2	99.2 ± 1.9	0.006
Oxygen saturation	88 ± 9	91 ± 7	0.002
Nursing home resident, %	2.5	1.5	0.74
Altered mental status present, %	11.0	8.4	0.50
Co-morbidities, %
History of liver disease	5.0	6.1	0.65
History of CHF	5.8	8.4	0.30
History of cardiovascular accident	9.6	8.4	0.73
History of renal disease	4.1	3.1	0.79
History of cancer	8.8	9.2	0.86
Chief complaint at triage, %
Fever	22.6	13.0	0.21
Dyspnea	38.0	37.4	0.92
Cough	38.6	35.9	0.60
Chest pain	22.9	24.4	0.72
Weakness/fatigue	12.1	9.2	0.42
Abdominal pain	4.1	6.1	0.34
Chief complaint to doctor, %
Fever	44.1	30.5	0.007
Dyspnea	47.4	42.0	0.31
Cough	61.7	51.9	0.06
Chest pain	32.0	35.1	0.52
Weakness/fatigue	11.3	10.7	1.0
Abdominal pain	7.4	7.6	1.0
Day of week, %
Sunday	9.6	16.8	0.18
Monday	16.3	13.7
Tuesday	16.5	12.2
Wednesday	15.2	13.7
Thursday	17.4	12.2
Friday	13.2	15.3
Saturday	11.9	16.0
Time of day, %
Early (7:00 - 14:59)	42.2	48.9	0.06
Mid-day (15:00 - 22:59)	39.4	41.2
Night (23:00 - 6:59)	18.5	9.9

Table 3. Characteristics of Cases Included in Multiple Logistic Regression Compared to Cases not Included due to Incomplete Antibiotic Data

Variable

Cases with complete antibiotic data
(n = 363)

Cases with incomplete antibiotic data
(n = 131)

P value

Age (mean ± SD)

62.7 ± 18.4

61 ± 17.5

0.37

Female, %

0.68

Triage vital signs (mean ± SD)

Pulse

109 ± 21

104 ± 20

0.008

Systolic BP

140 ± 30

143 ± 27

0.45

Respiratory rate

24 ± 8

23 ± 6

0.19

Temperature

99.8 ± 2.2

99.2 ± 1.9

0.006

Oxygen saturation

88 ± 9

91 ± 7

0.002

Nursing home resident, %

2.5

1.5

0.74

Altered mental status present, %

11.0

8.4

0.50

Co-morbidities, %

History of liver disease

5.0

6.1

0.65

History of CHF

5.8

8.4

0.30

History of cardiovascular accident

9.6

8.4

0.73

History of renal disease

4.1

3.1

0.79

History of cancer

8.8

9.2

0.86

Chief complaint at triage, %

Fever

22.6

13.0

0.21

Dyspnea

38.0

37.4

0.92

Cough

38.6

35.9

0.60

Chest pain

22.9

24.4

0.72

Weakness/fatigue

12.1

9.2

0.42

Abdominal pain

4.1

6.1

0.34

Chief complaint to doctor, %

Fever

44.1

30.5

0.007

Dyspnea

47.4

42.0

0.31

Cough

61.7

51.9

0.06

Chest pain

32.0

35.1

0.52

Weakness/fatigue

11.3

10.7

1.0

Abdominal pain

7.4

7.6

1.0

Day of week, %

Sunday

9.6

16.8

0.18

Monday

16.3

13.7

Tuesday

16.5

12.2

Wednesday

15.2

13.7

Thursday

17.4

12.2

Friday

13.2

15.3

Saturday

11.9

16.0

Time of day, %

Early (7:00 - 14:59)

42.2

48.9

0.06

Mid-day (15:00 - 22:59)

39.4

41.2

Night (23:00 - 6:59)

18.5

9.9