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J Emerg Med. 2013 Jul;45(1):1-7. doi: 10.1016/j.jemermed.2012.11.018. Epub 2013 Feb 26.

Time to first antibiotics for pneumonia is not associated with in-hospital mortality.

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  • 1Department of Emergency Medicine, Saint Anne's Hospital, Fall River, Massachusetts 02721, USA.



Time to first antibiotic (TTFA) is postulated to impact pneumonia mortality. The Joint Commission/Centers for Medicare and Medicaid Services national quality standards previously indicated that TTFA should be <6 h (modified from <4 h when the study was initiated, now eliminated as a time measure entirely).


The purpose of this article was to determine whether TTFA is associated with inpatient mortality.


The records of 444 consecutive patients admitted with pneumonia at a single institution were retrospectively reviewed for a correlation between TTFA and inpatient complications, including death. Statistical significance was set at p < 0.01 due to multiple comparisons.


Patients whose TTFA was <4 h had more complications (27% vs. 3%; p < 0.01) including death, intensive care unit admission, and intubation. These patients were judged sicker on arrival (median Emergency Severity Index 2 vs. 3; p < 0.001) and were more likely to be triaged to a critical care bed (36% vs. 5%; p < 0.001). Shortness of breath was the only presenting factor that was more frequent in the TTFA <4-h group (61% vs. 16%; p < 0.01).


Shorter TTFA is not associated with improved inpatient mortality. TTFA should not be considered to be a marker of quality of care but rather a reflection of patient disease severity.

Copyright © 2013 Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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