448 Letters to the Director / Arch Bronconeumol. 2010;46(8):445-450 5. Cardillo G, Carbone L, Carleo F, Masala N, Graziano P, Bray A, et al. Solitary fibrous tumors of the pleura: an análisis of 110 patients treated in a single institution. Ann Thorac Surg. 2009;88:1632-7. 6. Sánchez-Mora N, Cebollero-Presmanes M, Monroy V, Carretero-Albiñana L, Herranz- Aladro M, Alvarez-Fernández E. Tumor fibroso solitario pleural:características clinicopatológicas de una serie de casos y revisión de la bibliografía. Arch Bronconeumol. 2006;42:96-9. Patricia Mínguez Clemente, a, * Manuel Valle Falcones, a and Francisco Javier Moradiellos Díez b a Servicio de Neumología, Hospital Puerta de Hierro Majadahonda, Madrid, Spain b Servicio de Cirugía Torácica, Hospital Puerta de Hierro Majadahonda, Madrid, Spain *Corresponding author. E-mail address: patriciaminguez22@hotmail.com (P. Mínguez Clemente). Is it Possible to Improve the Management of Community Acquired Pneumonia in Hospital Emergency Departments? ¿Es posible mejorar el manejo de la neumonía adquirida en la comunidad en los servicios de urgencias hospitalarios? To the Editor: In 2008, the document “Management of community-acquired pneumonia in emergency departments” was published, 1 which was a collaboration between TIR-SEPAR (Area of Tuberculosis and Respiratory Infections of the Spanish Society of Pneumology and Thoracic Surgery) and INFURG-SEMES (Infections in Emergency Departments Study Group of the Spanish Society of Emergency Medicine). The objective of the document was to serve as a tool for reducing clinical variability and improving the comprehensive management of community-acquired pneumonia (CAP) in Hospital Emergency Services (HES). The document defines CAP as a disorder where there are “acute infectious compatible clinical features and its radiological demonstration.” Undoubtedly, one of its key points is based upon the importance of administering the first dose of antimicrobial as early as possible, which is also indicated by the experts, as recommended by several of the most significant guidelines. 2,3 This cannot only be feasible in HES, but it needs to be an overriding aim today. 4 Experience shows that achieving this is not an easy task. This is due to many adverse factors (HES saturation, hospital admissions awaiting free beds, total number of emergencies per day and number of patients assigned per doctor), which have proven to be independent predictors of the delay in administering the antibiotic for CAP within the first 4 hours in HES. 5 However, in order to achieve the early administration of the antibiotic, we decided to do the following: improve the triage or the initial evaluation of the patient; carry out an early detection of patients with CAP and/or criteria for sepsis; implement a management protocol for patients with suspected CAP (the above-mentioned SEMES-SEPAR document); and implement systematically a prognostic score to better complement the decision of admission or discharge, thus determining and administering the appropriate treatment at an early stage. 6 It is well known that adherence to clinical practice guidelines has shown a reduction in mortality, an improvement in the adequacy and precocity of treatments and an optimisation in the use of additional tests, thus increasing the rate of diagnoses achieved by HES. Therefore, we carried out a single-blind, prospective observational study from 6 January 2008 to 30 September 2008 (control group) and from 10 April 2008 to 15 January 2009 (study group) of adult patients with CAP in HES. The aim of the study was to analyse the performance, differences and improvement in the management of CAP, following the implementation of “the aforementioned 2008 SEMES-SEPAR recommendations for HES,” by comparing the implementation of a previous group with a subsequent one. For the comparative analysis we used the SPSS 14.0 package (Student’s t-test, Mann-Whitney U test and Yates’ chi-square test for proportions, considering the p < 0.05 value as significant difference). Table 1 shows some of the results obtained. Independent partners carried out the selection and inclusion of the patients and their subsequent follow-ups, until we had 100 consecutive confirmed cases in each group. These Results GC N = 100 SG N = 100 Difference SSa/SSb criteria (%) 8 10 NSD Appropriate empirical antimicrobial treatment (%) 62 97 p < 0.05 Antibiotic administration within 4 h (%) 31 90 p < 0.05 Duration of antibiotic treatment (days) 12.5 9.1 p < 0.05 Hospital stay (days) 8.6 ± 6.2 6.3 ± 4.4 p < 0.05 Appropriate request for additional/microbiological tests (%) 18 74 p < 0.05 Obtaining final microbiological diagnosis (%) 22 47 p < 0.05 Discharge rate on the first visit from the emergency department (including observation within 24 h) (%) 38 42 NSD Admission to SSU (24-72 h) (%) 23 26 NSD Admission to a ward (%) 30 24 NSD Admission to ICU (%) 9 8 NSD Revisit within 30 days following the initial discharge from the HES (%) 17 8 p < 0-05 Total cumulative mortality at 30 days (%) 11 8 NSD Table 1 Comparative results before and after implementing the INFURG-SEMES and TIR-SEPAR recommendations CG indicates control group (prior to the recommendations); HES, Hospital Emergency Services; ICU, ontensive care unit; N, number of total patients in each group; NSD, no significant differences; SG, study group (post-implementation of the recommendations); SSa, severe sepsis; SSb, septic shock; SSU, short-stay unit.