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The present study aimed at providing a comprehensive approach for clinician for evaluation and effective management of CAP based on sound evidence and unified guidelines.
A prospective case-control study conducted at a University hospital ”Abo El Resh hospital” which is following a systematic approach for management of CAP and is greatly adherent to evidence based guidelines. Researcher searched PubMed, Cochrane central Register of controlled trial, EMBASE to identify studies that assessed the clinical efficacy and outcome of management of CAP based on evidence based guidelines, and full articles of potentially appropriate abstracts were included. The study intending to conduct a Meta-analysis was limited but it was performed choosing a university hospital, which was following an evidence-based model of management of CAP.
Subjects included in the study were preschool children admitted or referred to Abo El Resh hospital suffering from community acquired pneumonia (CAP), the practical part of the study took 6 month for observation and data collection & 6 month for follow up, subjects were divided into 2 groups:
1) Evidence based medicine group (EBM group): This group included 28 of preschool children presented with symptoms suggestive of acute respiratory infection (pneumonia) admitted to Abo El Resh hospital shortly after onset of illness and managed on evidence based protocol and systematic approach.
2) Non-evidence based medicine group (NEBM group): This group included 28 of preschool children suffering from CAP referred to Abo El Resh hospital after empirical, delayed and non-evidence based management for their illness.
For all children the following were done:
I) full clinical assessment through:
II) Diagnostic Testing:
a) Complete white blood cell and differential count
b) Acute-Phase Reactants (APR)
c) Chest radiograph
d) Blood culture
e) Assessment of severity of pneumonia
f) Assessment of oxygenation
The demographic characteristics of both groups demonstrated that a large proportion of studied patients were males 32 (57.2%) and only 24 females (42.8%), with a male to female ratio of 1.3. Their age ranged from 1 to 72 months, age category from 1 month to 2 years, were 42 (75%) while the rest from 2 to 5 years, were 14 (25%) commonly the order of child was 3rd or forth sibling, nearly all patients received their scheduled vaccination and no one received pneumococcal vaccine. Observing cases managed on EBM and NEBM revealed a highly statistical significant difference as regard the regimen of therapy especially antimicrobial treatment between EBM and NEBM group which started shortly after admission and NEBM group which have empirical and delayed start of appropriate treatment with a mean duration 6.8±2.1 days ranging from 3 up to 10 days (P=0.001).
As regard the outcome of NEBM group , they need to be admitted to ICU for certain duration with a mean 4.2±2.6 days while no patients of EBM group needed to be admitted to ICU showing high statistically significant difference between 2 groups (P=0.001).