Department of Emergency Medicine - Duke University Medical Center Durham, NC 27710, USA.
Am J Emerg Med. 2010 Oct;28(8):862-5. doi: 10.1016/j.ajem.2009.04.014. Epub 2010 Mar 25.
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.
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.
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% CI, 13-24), renal disease (16%; 95% CI, 13-19), other infections (9%; 95% CI, 7-11), cardiovascular diseases (3%; 95% CI, 2-4), and other miscellaneous diagnosis (28%; 95% CI, 25-31).
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.
本研究旨在描述急诊科（ED）因社区获得性肺炎（CAP）入院但最终出院诊断非肺炎的患者中，出现肺炎样体征和症状的流行情况。
在 3 所学术医院，通过经过培训的提取器对所有因 CAP 入院的成年患者进行回顾性、结构化的 ED 患者 CAP 图表审查。使用预定的病例报告表提取人口统计学数据、肺炎患者结局研究小组评分和出院诊断数据（国际疾病分类，第 9 版[ICD-9]代码）。
从 3 家医院的 ED 共收治 800 例 CAP 患者，最终有 219 例（27.3%；95%置信区间[CI]，24-31）出院诊断为非肺炎。该组患者的特征包括平均年龄 62.6 岁，女性占 50%，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 例（65%）的胸部 X 线检查异常，13%的患者血氧饱和度异常。该队列中有 91.5%的患者存在咳嗽、咳痰、发热、呼吸急促或白细胞增多，其中 63.8%的患者至少有 2 种这些发现。还确定了 20 种替代 ICD-9，包括非 CAP 肺部疾病（18%；95%CI，13-24）、肾脏疾病（16%；95%CI，13-19）、其他感染（9%；95%CI，7-11）、心血管疾病（3%；95%CI，2-4）和其他各种诊断（28%；95%CI，25-31）。
我们的数据表明，ED 对 CAP 的诊断经常与出院诊断不同。这可能是因为 CAP 的诊断依赖于潜在非特异性的临床和影像学特征的组合。需要新的具有更好特异性的诊断方法和工具来改善 CAP 在 ED 的诊断。
