The NHS serves an aging population and is world renowned for providing high quality health care. However, hospitals are not intrinsically safe places to stay, especially for the elderly, with nosocomial, antibiotic resistant infections a particularly headline-inducing concern. One of the most prevalent nosocomial infections is Hospital Acquired Pneumonia (HAP). Hospital Acquired Pneumonia has a high mortality, tends to affect an elderly population and is more likely to be secondary to an antibiotic resistant micro-organism than it’s community-acquired neighbour.
Despite these facts, HAP has had much less research into it than Community Acquired Pneumonia (CAP). One of the major international success stories in CAP research in recent years has been the development of severity scoring indices at diagnosis to help guide treatment decisions, place of therapy and intensive care review when necessary. Prior to this study, the author was not aware of any such score for HAP, and the overarching aim of this thesis is to investigate if there are any applicable HAP severity scores, if the evidence supports their use in the UK HAP population and whether or not they are currently recommended.
The thesis takes the form of an introduction to the topic, a scoping review into severity scoring indices in HAP- looking at both guidelines and original research, a case study original piece of research and finally recommendations for further research in the area. The outcomes of the scoping review concluded that the research into the area is currently inadequate. The case study, however, supported the notion that severity scoring indices may have a useful role in prognostication at diagnosis. Further research is desperately needed and the case for this and focus for this is set out in detail in the conclusion of this thesis. The broad suggestion, however, is for a large multi-centre study applying scoring indices to UK HAP population to assess prognostication, involvement of a stakeholder group to ensure appropriate metrics are reviewed, and two scores are suggested to use in this study following promising results at prognosticating in the case study- the I-ROAD score, and the PSI.