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Inpatient care of community-acquired pneumonia: DISCUSSION (2)

We were unable to detect an association between guideline adherence and mortality or LOS. The apparent lack of association could be due to a true lack of benefit from guideline adherence, inadequate power to detect a difference or a systematic difference between guideline-adherent and guideline-discordant cases not accounted for in the multivariable analysis. In the case of mortality, inadequate power is particularly likely given the relatively small number of patients reaching the end point and the relatively small number of cases not treated according to guidelines. buy asthma inhaler
Analyzing all guideline-adherent cases versus all guideline-discordant cases together, regardless of era, would have increased study power. This was not done because of significant differences between guideline versions. Given the older age and higher PSI score in guideline-adherent cases, it is unlikely that deviation from guidelines was random. Although we controlled for PSI and study site, there may have been other important prognostic factors that were imbalanced between groups. Regarding LOS, we also controlled for comorbid illness and long-term care (not significant), but indexes of comorbidity severity were unavailable. There was a shorter duration of IV antibiotic therapy in guideline-adherent cases in the recent era. Also, recent cohort guideline-adherent cases had a shorter duration of IV antibiotic therapy than early cohort guideline-adherent cases, which is explained by the use of levofloxacin and its associated rapid conversion to oral therapy.