Hospital deaths from the most common form of pneumonia decreased by 14% between 2009 and 2015 according to new research published online in Thorax, the journal of the British Thoracic Society (BTS.)
The UK study showed that key elements of hospital care for community acquired pneumonia (CAP) improved during this period and could have contributed to the fall in deaths – including:
- An 11.5% increase in the proportion of adults who received their first dose of antibiotics within 4 hours of being admitted to hospital
- A 3.7% increase in the proportion of adults who had a chest x-ray to help confirm the diagnosis within 4 hours of being admitted to hospital
- A 1.7% increase in the administration of appropriate antibiotics, in line with local guidelines
The research analysed data from 23,315 UK hospital admissions for community acquired pneumonia (CAP) across 6 years between 2009 and 2014.
Overall, pneumonia is the sixth biggest cause of death in the UK. It kills 29,000 people a year and is the third biggest cause of death from lung disease – with deaths mainly occurring in older people and children & babies under 10 years. Around 220,000 people receive a diagnosis of pneumonia each year.
Lung specialists have pointed to the probable role of national medical guidelines, from the British Thoracic Society and NICE, in helping drive these improvements. But they have also warned against complacency as the death rate in UK from pneumonia is the third highest in Europe.
The reduction in inpatient deaths, which occurred within 30 days of hospital admission, happened despite there being no change in the severity of the disease when the patient was admitted and the average age of the patient actually increasing over the 6 years studied.
The joint study was undertaken by the Department of Respiratory Medicine, Nottingham University Hospital’s NHS Trust and the British Thoracic Society.
Key information and facts about pneumonia:
- Pneumonia is an inflammation of one or both lungs, usually caused by an infection. The inflammation causes the air sacs (alveoli) inside the lungs to fill with fluid. This makes it harder for the lungs to work properly. Many different kinds of bacteria, viruses and, occasionally, fungi can cause pneumonia.
- It accounts for more hospital admissions and bed days than any other lung disease. Over 200,000 admissions and 2.3 million bed days each year are due to the disease.
- It kills 40% more women than men. From 2008 to 2012, nearly 87,000 women and over 61,000 men died of the disease.
- Cases per 100,000 were 20% higher in 2009 than other years. This may be linked to the winter of 2009-10 being the coldest in over 30 years, or it may be linked to the swine flu pandemic of the same year.
- Pneumonia is more common in older people but pneumonia and acute lower respiratory tract infections (LRTIs) kill more children under 15 than any other lung disease. These diseases account for 3.5% of all deaths in this age group.
‘The Battle for Breath: the impact of lung disease in UK’; British Lung Foundation 2016
Professor Wei Shen Lim, consultant respiratory specialist at Nottingham University Hospitals NHS Trust and member of the British Thoracic Society said;
“This fall in pneumonia deaths within 30 days of admission to hospital is very encouraging and suggests that local NHS hospitals have put in place measures to improve diagnosis, treatment and care.
We hope that improvements continue to be made and that the new ‘Quality Standard’ from NICE accelerates this process.
There are a number of simple steps that hospitals can take to reduce the death toll. These include patients with suspected community acquired pneumonia receiving an x-ray and diagnosis within 4 hours of admission, a mortality risk assessment being taken on diagnosis, and antibiotic therapy started within 4 hours of admission.
Variations in deaths are apparent across the UK however and BTS is working to further understand these variations and support centres that are striving towards improvements.’
For more BTS information and resources on evidence-based steps (known as a ‘care bundle’) hospitals can take to diagnose and care for patients with community acquired pneumonia effectively click here: https://www.brit-thoracic.org.uk/audit-and-quality-improvement/bts-care-bundles-for-cap-and-copd/
Dr Lisa Davies, Consultant Respiratory Physician, University Hospital Aintree NHS Foundation Trust, Liverpool and Chair of the British Thoracic Society’s Board, said:
‘Pneumonia is a killer, and places a huge health and economic burden on NHS and society – especially during the Winter. This research is really encouraging and shows that if NHS hospitals put in place simple steps, they have the power to save lives from pneumonia.
Looking wider, we also need a systematic approach in the community to prevent pneumonia happening in the first place and help speed up diagnosis.
This should involve patient education for at risk groups about the need to tackle winter illnesses early before they escalate, targeted vaccination, and national guidance being implemented in the community on the first steps to diagnosing the disease.’