Inappropriate Diagnosis of Pneumonia Among Hospitalized Adults Article Swipe
Ashwin Gupta
,
Scott A. Flanders
,
Lindsay A Petty
,
Tejal Gandhi
,
Michael S. Pulia
,
Jennifer Horowitz
,
David Ratz
,
Steven J. Bernstein
,
Anurag N. Malani
,
Payal Patel
,
Timothy P. Hofer
,
Tanima Basu
,
Vineet Chopra
,
Valerie M. Vaughn
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamainternmed.2024.0077
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamainternmed.2024.0077
Importance Little is known about incidence of, risk factors for, and harms associated with inappropriate diagnosis of community-acquired pneumonia (CAP). Objective To characterize inappropriate diagnosis of CAP in hospitalized patients. Design, Setting, and Participants This prospective cohort study, including medical record review and patient telephone calls, took place across 48 Michigan hospitals. Trained abstractors retrospectively assessed hospitalized patients treated for CAP between July 1, 2017, and March 31, 2020. Patients were eligible for inclusion if they were adults admitted to general care with a discharge diagnostic code of pneumonia who received antibiotics on day 1 or 2 of hospitalization. Data were analyzed from February to December 2023. Main Outcomes and Measures Inappropriate diagnosis of CAP was defined using a National Quality Forum–endorsed metric as CAP-directed antibiotic therapy in patients with fewer than 2 signs or symptoms of CAP or negative chest imaging. Risk factors for inappropriate diagnosis were assessed and, for those inappropriately diagnosed, 30-day composite outcomes (mortality, readmission, emergency department visit, Clostridioides difficile infection, and antibiotic-associated adverse events) were documented and stratified by full course (>3 days) vs brief (≤3 days) antibiotic treatment using generalized estimating equation models adjusting for confounders and propensity for treatment. Results Of the 17 290 hospitalized patients treated for CAP, 2079 (12.0%) met criteria for inappropriate diagnosis (median [IQR] age, 71.8 [60.1-82.8] years; 1045 [50.3%] female), of whom 1821 (87.6%) received full antibiotic courses. Compared with patients with CAP, patients inappropriately diagnosed were older (adjusted odds ratio [AOR], 1.08; 95% CI, 1.05-1.11 per decade) and more likely to have dementia (AOR, 1.79; 95% CI, 1.55-2.08) or altered mental status on presentation (AOR, 1.75; 95% CI, 1.39-2.19). Among those inappropriately diagnosed, 30-day composite outcomes for full vs brief treatment did not differ (25.8% vs 25.6%; AOR, 0.98; 95% CI, 0.79-1.23). Full vs brief duration of antibiotic treatment among patients was associated with antibiotic-associated adverse events (31 of 1821 [2.1%] vs 1 of 258 [0.4%]; P = .03). Conclusions and Relevance In this cohort study, inappropriate diagnosis of CAP among hospitalized adults was common, particularly among older adults, those with dementia, and those presenting with altered mental status. Full-course antibiotic treatment of those inappropriately diagnosed with CAP may be harmful.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamainternmed.2024.0077
- https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2816759/jamainternal_gupta_2024_oi_240004_1710785795.21061.pdf
- OA Status
- hybrid
- Cited By
- 35
- References
- 33
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4393150791
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4393150791Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamainternmed.2024.0077Digital Object Identifier
- Title
-
Inappropriate Diagnosis of Pneumonia Among Hospitalized AdultsWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-03-25Full publication date if available
- Authors
-
Ashwin Gupta, Scott A. Flanders, Lindsay A Petty, Tejal Gandhi, Michael S. Pulia, Jennifer Horowitz, David Ratz, Steven J. Bernstein, Anurag N. Malani, Payal Patel, Timothy P. Hofer, Tanima Basu, Vineet Chopra, Valerie M. VaughnList of authors in order
- Landing page
-
https://doi.org/10.1001/jamainternmed.2024.0077Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2816759/jamainternal_gupta_2024_oi_240004_1710785795.21061.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
-
https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2816759/jamainternal_gupta_2024_oi_240004_1710785795.21061.pdfDirect OA link when available
- Concepts
-
Medicine, Community-acquired pneumonia, Pneumonia, Incidence (geometry), Odds ratio, Emergency department, Diagnosis code, Medical record, Prospective cohort study, Internal medicine, Retrospective cohort study, Pediatrics, Emergency medicine, Population, Environmental health, Optics, Psychiatry, PhysicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
35Total citation count in OpenAlex
- Citations by year (recent)
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2025: 20, 2024: 15Per-year citation counts (last 5 years)
- References (count)
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33Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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