Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes.
J Hosp Med. 2014 Nov 1;
Authors: Lanspa MJ, Peyrani P, Wiemken T, Wilson EL, Ramirez JA, Dean NC
BACKGROUND: Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes.
OBJECTIVE: We analyzed patient-level covariates associated with clinician-defined aspiration pneumonia.
METHODS: We used the Community-Acquired Pneumonia Organization database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with nonaspiration pneumonia.
RESULTS: We studied 5185 patients. Four hundred fifty-one of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with nonaspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs 13%, P = 0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P < 0.001), and took longer to achieve clinical stability (unadjusted 8 vs 4 days, P < 0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (odds ratio: 4.4, 2.9, 2.3, respectively). Unadjusted inpatient mortality was higher (23% vs 9%, P < 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality after adjusting for age, disease severity, and comorbidities.
CONCLUSIONS: Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration. Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine.
PMID: 25363892 [PubMed - as supplied by publisher]