Pneumonia in the Emergency Department: controversial aspects in daily clinical practice

Community-acquired pneumonia (CAP) is one of the most frequent and challenging disease that Emergency Physicians have to face in the Emergency Department, with high morbidity and mortality. The lack of specificity of onset symptoms, radiological signs and laboratory tests makes the diagnosis of pneumonia far to be simple. In a time-dependent setting, a difficult decision-making - including proper assessment and diagnostic strategies, therapeutical management and future patient’s allocation - is required to Emergency Physician. In this context, due to high-rate mortality of severe CAP, prompt recognition of the disease severity is a crucial point and rapid risk-calculation for multi-drug resistant organisms is encouraged, in order to ensure the right therapy, at the right time and in the right place, both avoiding under and overtreatment. The aim of this article is to discuss the main practical issues that intensivists are supposed to deal with when they approach patients with suspected pneumonia, according to previous data and current guidelines.