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Admission and Discharge Guideline

These recommendations serve as a guide and clinicians are encouraged to use clinical judgment to manage all cases.

These guidelines may change as per revision by Government of India.


         Diagnostic studies

         Patient stratification

         Pneumonia Severity Index

         Patients with asthma have increased risk of complications and may warrant hospital admission.

      •         Need for hospitalization


         In general, patients in risk Class I and II may be managed as outpatients. Outpatient management of patients in risk Class III may be considered after assessment of patient’s clinical condition, follow-up, and home environment.

         Need for admission to an intensive care unit


Typical diagnostic work-up

Vital signs

         Chest x-ray (PA and lateral)

         Complete blood count (CBC) with differential

         Basic metabolic panel

         Hepatic profile

         Pulse oximetry and/or ABG


In addition, the following are recommended for Risk Class III-V and should be considered for

Risk Class I-II:

         Blood cultures x 2

         Sputum for Gram's stain and culture



Additional diagnostics to consider:

         HIV test

         ECG-12 leads

         Immunocompromised (including HIV):

         Consider other causes of pneumonia (e.g. fungal, viral,TB, PCP)/secondary bacterial/atypical pneumonia and other diagnostics



Calculating risk score;





Demographic factors


1.      Men

Age in years

2.      Women

Age in years minus 10

3.      Nursing home residents


4.      Coexisting diseases


a)      Neoplastic Disease


b)      Liver Disease


c)      Congestive heart failure


d)     Cerebrovascular Disease


e)      Renal Disease



Physical Examination


1.      Altered Mental Status


2.      Respiratory rate >30/min


3.      Systolic B.P. <90 mmhg


4.      Temperature <35.C or >40.C


5.      Pulse >125/min



Investigation Findings


1.      Arterial PH < 7.35


2.      Blood Urea Nitrogen  >30mg/dl


3.      S. Na <130


4.      Blood Sugar > 250mg/dl


5.      Haematocrit < 30%


6.      SPO2  <90%


7.      Pleural Effusion







Stratification of Risk Score;



Risk Class






Based on Alogrithm


Consider treatment as






Consider treatment as




71 – 90


Consider hospitalization



91 - 130


Admit to hospital





Admit to hospital


Start the treatment according to the treatment guidelines for Influenza A H1N1



In case of children, indications for hospitalization include

·         Hypoxemia (oxygen saturation consistently less than 90 percent in room air)

·         Dehydration, or inability to maintain hydration orally; inability to feed in an infant

·         Moderate to severe respiratory distress: respiratory rate >70 breaths/min in infants <12 months or >50 breaths/min in older children, difficulty breathing, apnea, grunting

·         Toxic appearance, which is more common in children with bacterial pneumonia, may

·         suggest a more severe course of pneumonia (e.g., cardiopulmonary compromise)

·         Underlying conditions that may predispose to a more serious course of pneumonia (e.g., cardiopulmonary disease), might be worsened by pneumonia (e.g., metabolic disorder), or might adversely affect response to treatment (e.g., immunocompromised host)

·         Presence of complications (e.g., effusion/empyema)

·         Failure of outpatient therapy (worsening or no response in 24 to 72 hours)




Criteria for IV to PO conversion

Clinical improvement in pulmonary signs and symptoms Afebrile or consistent improvement in fever over a 24-hour period WBC count normalizing.

Infection being treated does not require IV therapy.

GI absorption likely normal (absence of vomiting or abnormal GI anatomy) Ability to receive oral dosage form either orally or via tube (concomitant oral or via tube administration of other meds).





Evaluate for discharge based on the following criteria:

         Stable co-morbid illnesses and significant improvement in pneumonia


Should also fulfill the following criteria (unless baseline status):

         Temperature < 37.8°C (> 24 hours and in the absence of antipyretics)

         Pulse < 100 beats/min

         Respiratory rate < 24 breaths/min

         SBP > 90 mmHg

         O2 saturation > 90% (at room air)

         Ability to maintain oral intake






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