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Medical Decision Making
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Withholding or Starting Antibiotic Treatment in Patients with Dementia and Pneumonia: Prediction of Mortality with Physicians’ Judgment of Illness Severity and with Specific Prognostic Models

Jenny T. van der Steen, PhD

Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands, Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands, j.vandersteen{at}vumc.nl

Marcel E. Ooms, MD, PhD

Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands, Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands

Gerrit van der Wal, MD, PhD

Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands

Miel W. Ribbe, MD, PhD

Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands, Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands

Background. To help decision makers plan treatment, the authors assessed clinical predictors of mortality from nursing home-acquired pneumonia in patients with dementia.Methods. Pneumonia patients treated without (n = 165) or with antibiotics (n = 541) were enrolled in a prospective cohort study in 61 nursing homes.Results. In both groups, clinical judgment of illness severity was a strong predictor for 1-week mortality. Despite large differences in frailty and mortality (83% in untreated patients and 15% in treated patients), separate multivariable logistic models included similar specific predictors.Discussion. Despite profound differences between the 2 independent groups, predictors for short-term mortality were largely similar. We found that, when combined with physicians’ clinical judgment, 3 readily assessed predictors (respiratory rate, fluid intake, and eating dependency) helped predict mortality. Our results, if confirmed in an independent population, can help make decision making about antibiotic treatment of pneumonia in patients with dementia more evidence-based.

Key Words: pneumonia • withholding treatment • decision making • prognosis • severity of illness index • statistical models • nursing homes

Medical Decision Making, Vol. 25, No. 2, 210-221 (2005)
DOI: 10.1177/0272989X05275400
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