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Pleural effusions at first emergency department encounter predict worse clinical outcomes in pneumonia patients.
Chest. 2016 Jan 16;
Authors: Dean NC, Griffith PP, Sorensen J, McCauley L, Jones BE, Lee YC
Abstract
BACKGROUND: Pleural effusions are present in 15% to 44% of hospitalized pneumonia patients. Whether effusions at first presentation to the emergency department (ED) effect outcomes, or should be managed differently is unknown.
METHODS: We studied patients in 7 hospital EDs with ICD-9 codes for pneumonia, or empyema, sepsis, or respiratory failure with secondary pneumonia, excluding patients without confirmatory chest imaging. We identified pleural effusions by radiographic imaging.
RESULTS: Over 24 months, 4771 of 458,837 adult ED patients fulfilled entry criteria. Among 690 (14.5%) with pleural effusion(s), median age was 68 years and 46% were male. Patients with higher Elixhauser scores (OR=1.13, CI=1.09-1.18, p<0.001), brain-natriuretic peptide (OR=1.20, CI=1.12-1.28, p<0.001), bilirubin (OR=1.07, CI=1.00-1.15,p=0.04), and age (OR=1.15, CI=1.09-1.21, p<0.001) were more likely to have parapneumonic effusion(s). In patients without effusion, electronic CURB-65 (eCURB) accurately predicted mortality (4.7% predicted vs. 5.0% actual). However, eCURB underestimated mortality in those with effusion(s) (predicted 7.0% vs. actual 14.0%, p<0.001). Patients with effusion(s) were more likely to be admitted (77% vs. 57%, p<0.001), and had longer hospital stay (median 2.8 vs. 1.3 days, p<0.001). After severity adjustment, likelihood of 30-day mortality was greater among patients with effusion(s) (OR=2.6, CI 2.0-3.5, p<0.001), and hospital stay was disproportionately longer (Coefficient 0.22, CI=0.14 to 0.29, p<0.001).
CONCLUSIONS: Pneumonia patients with pleural effusions at ED presentation were more likely to die, be admitted, and had longer hospital stays. Why parapneumonic effusions are associated with adverse outcomes, and whether different management of these patients might improve outcome needs urgent investigation.
PMID: 26836918 [PubMed - as supplied by publisher]