# Management and documentation of pneumonia – a comparison of patients consulting primary care and emergency care

## TL;DR

The study compares how pneumonia patients are managed in primary and emergency care, finding that vital signs are less documented in primary care and patients there tend to have milder cases.

## Contribution

The study introduces a comparison of pneumonia management and documentation practices between primary and emergency care settings in Sweden.

## Key findings

- Vital signs were less frequently documented in primary care compared to emergency care.
- Primary care patients had milder pneumonia symptoms and less severe vital sign changes.
- The traffic light scoring model identified more high-risk patients in emergency care than the CRB-65 model.

## Abstract

Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia.

To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral.

Medical record review of vital signs, examination findings and severity of pneumonia.

Primary and emergency care.

Two hundred and forty patients diagnosed with pneumonia.

Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65.

Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection.

Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.

Pneumonia patients attending primary care have less affected vital signs than those attending emergency care.Vital signs were less documented in primary care than in emergency care.Patients with pneumonia seem to attend the correct level of care when they have the possibility to choose without a referral.CRB-65 was not possible to count in most primary care patients due to lack of documentation.

Pneumonia patients attending primary care have less affected vital signs than those attending emergency care.

Vital signs were less documented in primary care than in emergency care.

Patients with pneumonia seem to attend the correct level of care when they have the possibility to choose without a referral.

CRB-65 was not possible to count in most primary care patients due to lack of documentation.