Establishing and Implementing Pneumonia Diagnosis in ED Older Adults: A Mixed Methods Approach

在急诊科老年人中建立和实施肺炎诊断：混合方法

• 批准号: 10513959
• 负责人: Katherine Hunold Buck
• 金额: $ 23.92万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10513959
• 关键词: Accident and Emergency department; Address; Adoption; Adult; Adverse effects; Antibiotics; Bacteria; Bacterial Infections; Bacterial Pneumonia; Biological Markers; COVID-19 impact; Caring; Cessation of life; Clinical; Communities; Defensins; Development; Diagnosis; Diagnostic; Diagnostic tests; Early Diagnosis; Elderly; Emergency Department Physician; Emergency Department patient; Emergency Medicine; Emergency department visit; Ensure; Event; Face; Female; Future; Genes; Geriatrics; Goals; Guidelines; Health; Human; Image; Infection; Innate Immune System; Investigation; Lead; Length of Stay; Leukocytes; Life; Maps; Measures; Methods; Mission; Modeling; Morbidity - disease rate; Natural Immunity; Outcome; Participant; Pathway interactions; Patient Care; Patients; Physicians; Pneumonia; Proteins; Recording of previous events; Research Priority; Respiratory Failure; Rural; Savings; Sepsis; Serum; Source; Subgroup; Symptoms; Testing; Theoretical Domains framework; Thinking; Thoracic Radiography; Time; United States; Validation; Viral; Viral Pneumonia; Virus; Virus Diseases; Width; Work; accurate diagnosis; adverse outcome; alpha-Defensins; antimicrobial peptide; care outcomes; clinical care; clinical diagnostics; co-infection; comorbidity; concept mapping; diagnostic accuracy; diagnostic criteria; diagnostic strategy; experience; future implementation; human old age (65+); implementation barriers; implementation science; implementation study; implementation trial; improved; male; monocyte; mortality; novel; novel diagnostics; novel marker; pathogen; pathogenic bacteria; pathogenic virus; predictive modeling; prevent; prospective; tool; usability; validation studies; young adult

PROJECT SUMMARY/ABSTRACT In the time it takes to read this application, 20 older adults (age≥65 years) will die of pneumonia in the United States. Annually over 500,000 older adults received treatment in emergency departments (ED) for pneumonia. Unfortunately, ED physicians cannot accurately diagnose pneumonia in older adults because of atypical symptoms, chest x-ray inaccuracy, comorbidities, failure of pulmonary clinical prediction rules established with younger adults, and poor accuracy of available biomarkers. Emergency physician’s inability to diagnose pneumonia in older adults leads to delayed diagnosis, inadequate treatment, worsening infection, longer lengths of stay (6.6 days vs. 5.4), and mortality. Pneumonia can be caused by bacterial and viral pathogens alone or in combination. Bacterial pneumonia alone causes the adverse outcomes and faces the diagnostic challenges just described. The presence of viral pneumonia further complicates diagnosis. Bacterial and viral co-infection in all adults increase odds of death by 2.1 with expected greater deleterious effects on older adults. Unfortunately, when viral sources are detected our current diagnostic approach fails to reliably identify bacterial sources in the event of co-infections. This can lead to inappropriate care and highlights the importance of ensuring fast, accurate diagnosis of both bacterial and viral pneumonia. Unfortunately, available tests (serum, imaging) and patient presentation (symptoms, exam, and history) are unreliable for diagnosing pneumonia in older adult ED patients. Our previous results reveal that novel tests may improve diagnostic accuracy of pneumonia (antimicrobial peptides [AMPs] and monocyte distribution width [MDW]). AMPs are a part of the innate immune system and respond in minutes to bacteria and viruses. Monocyte distribution width measures the distribution of size of leukocytes and increases in ED sepsis. This project seeks to build on previous investigations to improve the diagnostic accuracy of pneumonia in older adult ED patients with the long-term goal of improving clinical care and decreasing the morbidity and mortality associated with pneumonia. Aim #1 examines the potential for novel tests (AMPs and MDW) to diagnose pneumonia alone and in combination with patient presentation/symptoms and existing diagnostic studies. This aim will consider pneumonia caused by bacterial pathogens, viral pathogens and the combination separately to create and determine the accuracy of a diagnostic pathway. Aim #2 will employ group concept mapping guided by the Theoretical Domains Framework to engage emergency physicians to identify facilitators and barriers to implementation of a diagnostic pathway in emergency medicine to inform future studies. Aim #3 pilots the Aim #1 diagnostic pathway. If successful, this proposal will produce a diagnostic pathway for pneumonia in older adult ED patients and provide the groundwork for a successful validation and implementation study of this diagnostic pathway.

项目摘要/摘要 在阅读此申请的时间里，有20名老年人（年龄≥65岁）将死于肺炎 美国。每年有超过500,000名老年人在紧急部门接受治疗（ED） 肺炎。不幸的是，ED医生无法准确诊断老年人的肺炎 非典型症状，胸部X射线不准确，合并症，肺临床预测的失败 急诊医师无法与年轻人建立，并且可用的生物标志物的精度差。 老年人诊断肺炎会导致诊断延迟，治疗不足，担心感染， 更长的住院时间（6.6天，5.4）和死亡率。 肺炎可能是由细菌和病毒病原体引起的，也可能是组合的。细菌 仅肺炎就会引起不良后果，并面临刚刚描述的诊断挑战。 病毒性肺炎的存在进一步使诊断复杂化。所有成年人的细菌和病毒共同感染增加 2.1死亡的几率对老年人的预期有害影响更大。不幸的是，当病毒时 检测到我们当前的诊断方法的来源无法可靠地识别细菌来源。 共同感染。这可能会导致不适当的护理，并突出确保快速，准确的重要性 诊断细菌和病毒性肺炎。 不幸的是，可用的测试（血清，成像）和患者表现（症状，检查和病史） 对于老年人ED患者的诊断性肺炎是不可靠的。我们先前的结果表明，新的测试 可以提高肺炎的诊断准确性（抗菌胡椒[AMPS]和单核细胞分布 宽度[MDW]）。放大器是先天免疫系统的一部分，并在几分钟内对细菌和病毒做出反应。 单核细胞分布宽度测量白细胞大小的分布和ED败血症的增加。 该项目旨在以先前的调查为基础，以提高肺炎的诊断准确性 在老年人ED患者中，其长期目标是改善临床护理并降低发病率和 与肺炎相关的死亡率。 AIM＃1考试新型测试的潜力（AMP和MDW） 单独诊断肺炎，并结合患者表现/症状和现有诊断 研究。该目标将考虑由细菌病原体，病毒病原体和组合引起的肺炎 分别创建和确定诊断途径的准确性。目标＃2将采用小组概念 由理论领域框架指导的映射，以吸引紧急医生以识别促进者 以及实施急诊医学诊断途径以告知未来研究的障碍。目标＃3 飞行员目标＃1诊断途径。如果成功，该建议将为 老年人ED患者的肺炎，为成功验证和 该诊断途径的实施研究。