A multicenter analysis of the ED diagnosis of pneumonia
A multicenter analysis of the ED diagnosis of pneumonia
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DOI：
10.1016/j.ajem.2009.04.014
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发表时间：
2010-10-01
影响因子：
3.6
通讯作者：
Limkakeng, Alexander
中科院分区：
文献类型：
--
作者：
Chandra, Abhinav;Nicks, Bret;Limkakeng, Alexander
目的：本研究的目的是描述从急诊科 (ED) 入院、诊断为社区获得性肺炎 (CAP) 但随后出院但诊断为非肺炎的患者中肺炎样体征和症状的患病率。 方法：由训练有素的提取人员对 3 所学术医院的 ED 患有 CAP 的患者进行回顾性、结构化的图表审查，对因社区获得性肺炎 (CAP) 入院的所有成年患者进行回顾性、结构化的图表审查。 CAP。使用预先确定的病例报告表提取人口统计数据、肺炎患者结果研究小组评分和出院诊断数据（国际疾病分类，第九版 [ICD-9] 代码）。结果：3 家医院共有 800 名被诊断为 CAP 的患者从急诊科入院，其中 219 名患者（27.3%；95% 置信区间 [CI]，24-31）最终获得了 CAP 诊断结果。 出院时诊断为非肺炎。该群体的特征包括平均年龄 62.6 岁，50% 为女性，有充血性心力衰竭 (CHF) (14%) 或癌症 (12%) 病史。排除缺失数据的患者后，123 名患者（65%）胸部 X 线检查异常，13% 血氧饱和度异常。该队列中 91.5% 的人出现咳嗽、咳痰、发烧、呼吸急促或白细胞增多，其中 63.8% 的人至少出现其中 2 项。确定了 20 个备用 ICD-9，包括非 CAP 肺部疾病（18%；95% Cl，13-24）、肾脏疾病（16%；95% Cl，13-19）、其他感染（9%；95% Cl，7-11）、心血管疾病（3%；95% Cl，2-4）和其他杂项诊断（28%；95% Cl， 25-31).结论：我们的数据表明 CAP 的 ED 诊断经常与出院诊断不同。这可能是因为 CAP 的诊断依赖于潜在的非特异性临床和放射学特征的组合。需要具有更好特异性的新诊断方法和工具来改善 CAP 的 ED 诊断。 (C) 2010 Elsevier Inc. 保留所有权利。
Objectives: The objective of this study was to describe the prevalence of pneumonia-like signs and symptoms in patients admitted from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP) but subsequently discharged from the hospital with a nonpneumonia diagnosis.Methods: A retrospective, structured, chart review of ED patients with CAP at 3 academic hospitals was performed by trained extractors on all adult patients admitted for CAP. Demographic data, Pneumonia Patient Outcomes Research Team scores, and discharge diagnosis data (International Classification of Diseases, Ninth Revision [ICD-9] codes) were extracted using a predetermined case report form.Results: A total of 800 patients were admitted from the ED with a diagnosis of CAP from the 3 hospitals, and 219(27.3%; 95% confidence interval [CI], 24-31) ultimately had a nonpneumonia diagnosis upon discharge. Characteristics of this group included a mean age of 62.6 years, 50% female, and a history of congestive heart failure (CHF) (14%) or cancer (12%). After excluding patients with missing data, 123 patients (65%) had an abnormal chest x-ray, and 13% had abnormal oxygen saturation. Cough, sputum production, fever, tachypnea, or leukocytosis were present in 91.5% of this cohort, and 63.8% had at least 2 of these findings. Twenty alternate ICD-9s were identified, including non-CAP pulmonary disease (18%; 95% Cl, 13-24), renal disease (16%; 95% Cl, 13-19), other infections (9%; 95% Cl, 7-11), cardiovascular diseases (3%; 95% Cl, 2-4), and other miscellaneous diagnosis (28%; 95% Cl, 25-31).Conclusions: Our data suggest that the ED diagnosis of CAP frequently differs from the discharge diagnosis. This may be due to the fact that a diagnosis of CAP relies on a combination of potentially nonspecific clinical and radiographic features. New diagnostic approaches and tools with better specificity are needed to improve ED diagnosis of CAP. (C) 2010 Elsevier Inc. All rights reserved.