Indicators of recurrent hospitalization for pneumonia in the elderly
Indicators of recurrent hospitalization for pneumonia in the elderly
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DOI：
10.1111/j.1532-5415.2004.52556.x
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发表时间：
2004-12-01
影响因子：
6.3
通讯作者：
Gough, M
中科院分区：
文献类型：
--
作者：
El Solh, AA;Brewer, T;Gough, M
目的：为确定老年社区获得性肺炎患者晚期非计划性再入院的可改变的危险因素，设计：病例对照研究，地点：三所大学附属三级医院，参与者：204对病例对照。病例指出院后30天至1年内因肺炎再次入院的所有患者。对照组被匹配的年龄，入院日期，和居住在admission.MEASUREMENTS：基线社会人口学信息，临床数据，日常生活活动（ADL）的信息，和Charlson Comorbid指数得分。肺炎严重程度指数计算吞咽功能障碍和模式和程度的放射学异常，抗菌药物覆盖率，和总的持续时间recorded.RESULTS：平均再入院时间为123天（四分位数间距=65-238天）。再次入院与严重程度或住院时间增加无关。在考克斯比例风险回归模型中，吞咽功能障碍（风险比（HR）=2.15，95%置信区间（CI）=1.46-2.97），目前吸烟（HR=2.04，95%CI =1.48-2.82）、使用镇静剂（HR=1.5，95%CI =1.02-2.22）和较低的ADL评分（HR=1.06，95%CI =1.02-1.10）与肺炎再入院独立相关。接受血管紧张素转换酶抑制剂（HR=0.46，95%CI =0.27-0.78）和既往肺炎球菌疫苗接种（HR=0.59，95%CI =0.42-0.82）具有保护作用。结论：虽然有有限的有效措施，以改善功能状态，预防策略，包括戒烟和肺炎球菌疫苗接种应积极推行。吞咽功能障碍的常规评估和使用药物改善咳嗽反射值得在多中心对照试验中进一步评估。
OBJECTIVES: To identify modifiable risk factors of late unplanned readmissions for elderly with community-acquired pneumonia.DESIGN: A case-control study.SETTING: Three university-affiliated tertiary-care hospitals.PARTICIPANTS: Two hundred four case-control pairs. Case patients referred to all patients readmitted with pneumonia 30 days to 1 year after discharge. Control subjects were matched for age, admission date, and residence before admission.MEASUREMENTS: Baseline sociodemographic information, clinical data, activity of daily living (ADLs) information, and Charlson Comorbidity Index score were obtained. The Pneumonia Severity Index was calculated with swallowing dysfunction and pattern and extent of radiographic abnormalities, antimicrobial coverage, and total duration recorded.RESULTS: Median time to readmission was 123 days (interquartile range=65-238 days). Readmission was not associated with increased severity or length of hospital stay. In a Cox proportional hazards regression model, swallowing dysfunction (hazard ratio (HR)=2.15, 95% confidence interval (CI)=1.46-2.97), current smoking (HR=2.04, 95% CI=1.48-2.82), use of tranquilizers (HR=1.5, 95% CI=1.02-2.22), and lower ADL scores (HR=1.06, 95% CI=1.02-1.10) were independently associated with readmission for pneumonia. The receipt of angiotensin-converting enzyme inhibitors (HR=0.46, 95% CI=0.27-0.78) and prior pneumococcal vaccination (HR=0.59, 95% CI=0.42-0.82) had a protective effect.CONCLUSION: Although there are limited effective measures to improve functional status, preventive strategies that include smoking cessation and pneumococcal vaccination should be actively pursued. Routine evaluation of swallowing dysfunction and use of pharmacological agents to improve the cough reflex deserve further evaluation in multicenter controlled trials.