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Criteria for evaluating, excluding, and enrolling residents in the Missouri LRI Project. |
| Residents eligible for evaluation met one or more of the following three criteria: |
| 1. Two or more new lower respiratory symptoms (e.g., cough, shortness of breath, cyanosis) |
| 2. One new respiratory symptom and at least one sign of an acute change in condition (e.g., fever, decreased alertness, new or increased confusion) |
| 3. At least one sign of an acute change in condition and no evidence of stroke, gastroenteritis, urine infection, constipation/fecal impaction, or an adverse drug reaction |
| Residents were excluded from evaluation if they met one or more of the following criteria: |
| 1. Did not meet evaluation criteria (above) |
| 2. Resident or a family member declined evaluation, or resident's physician excluded them from the protocol |
| 3. Resident's physician was not signed on to the protocol |
| 4. Resident was not well and off antibiotics for at least seven days following a prior LRI |
| 5. Resident was not at least 60 years of age |
| 6. Resident had less than one month life expectancy, resident was a hospice patient, or resident had AIDS |
| 7. Resident had a "no antibiotics" order in effect |
| 8. Illness episode was missed |
| 9. Resident had not been in facility for at least 14 days |
| The six enrollment criteria were |
| 1. New or increased cough |
| 2. New or increased sputum production |
| 3. Fever |
| 4. Pleuritic chest pain |
| 5. New or increased physical findings on chest examination (rales, rhonchi, wheezes, or bronchial breathing) |
| 6. One or more indications of change in status or breathing difficulty (new or increased shortness of breath, respiratory rate > 25, and worsening mental or functional status) |
| Residents were enrolled if, after evaluation, they met three or more of the above enrollment criteria, or they met two criteria and had chest x-ray findings positive for pneumonia. We further required that residents with congestive heart failure or chronic obstructive pulmonary disease had either a fever or a chest x-ray that was positive for pneumonia to avoid confusing an acute exacerbation of their condition with an LRI. |
Kruse and Mehr BMC Medical Research Methodology 2008 8:61 doi:10.1186/1471-2288-8-61 |