There are several clinical guidelines (Pneumonia Severity Index or CURB-65) to help risk-stratify patients and aid in the disposition. These guidelines consider risk factors associated with increased morbidity and mortality. Risk factors include elderly or nursing home residents, the presence of comorbid disease (congestive heart failure, cancer, liver disease, stroke, chronic renal disease), altered mental status, respiratory rate >30 breaths/min, systolic blood pressure <90 mmHg, temperature <35°C (95°F) or >40°C (104°F), pulse >125 bpm, pH <7.35, blood urea nitrogen >30 mg/dL, Na <130 mEq/L, glucose >250 mg/dL, hematocrit <30%, arterial pO2 <60 mmHg, and pleural effusion. Although these risk factors and clinical guidelines should be considered in deciding to admit a patient, other factors such as the social situation, ability to follow-up, and other medical conditions may also play a role in the decision to admit the patient. Consider infection control measures, as outlined previously, on all admitted patients.
Patients without a complicated course or risk factors and who have a good social situation may be discharged home with appropriate follow-up.