Department of Internal and Emergency Medicine, Buergerspital Solothurn, Solothurn.
Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
Eur J Emerg Med. 2022 Oct 1;29(5):366-372. doi: 10.1097/MEJ.0000000000000933. Epub 2022 Apr 8.
Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential.
To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP.
Retrospective cohort study.
Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018.
Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence.
In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07-0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05-0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08-0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03-0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04-0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07-0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, -14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, -0.18 to -0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81-12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67-2.23).
Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.
由于社区获得性肺炎（CAP）相关的高发病率和死亡率，早期识别和治疗至关重要。
研究在因 CAP 到急诊科就诊的患者中，年龄和性别与临床症状、影像学表现和结局之间的关系。
回顾性队列研究。
2017 年 1 月 1 日至 2018 年 12 月 31 日期间，在瑞士一家急诊科接受放射学确诊的 CAP 治疗的患者。
主要目的是评估男性与女性和 65 岁以上与<65 岁 CAP 患者之间的临床和影像学表现差异。次要结局是年龄和性别相关的肺炎严重指数（PSI）风险类别、需要 ICU 转诊、机械通气、院内死亡率、30 天再入院和 180 天肺炎复发方面的差异。
共纳入 467 例 CAP 患者，其中 211 例为女性（45%），317 例年龄≥65 岁（68%），其中 145 例为女性（46%）。老年患者较少报告胸痛（13% vs. 27%；效应量 14%；95%CI，0.07-0.23）、发热（39% vs. 53%，效应量 14%；95%CI，0.05-0.24）、寒战（6% vs. 20%，效应量 14%；95%CI，0.08-0.214）、咳嗽（44% vs. 57%，效应量 13%；95%CI，0.03-0.22）、头痛（5% vs. 15%，效应量 10%；95%CI，0.04-0.17）和肌痛（5% vs. 19%，效应量 14%；95%CI，0.07-0.21）。然而，85%无症状患者年龄≥65 岁。女性的 PSI 较低[95（SD 31） vs. 104（SD 31）；95%CI，-14.44 至 2.35]，男性更常见咳痰（32% vs. 22%；效应量 10%；95%CI，-0.18 至-0.02）。老年患者的死亡率较高（14% vs. 3%；优势比（OR），4.67；95%CI，1.81-12.05），而男性和女性之间的死亡率相似（11% vs. 10%；OR，1.22；95%CI，0.67-2.23）。
因 CAP 到急诊科就诊的<65 岁患者与 65 岁以上患者相比，其胸痛、发热、寒战、咳嗽、头痛和肌痛等典型症状更为明显。除入院时的 PSI 外，男性和女性在临床表现、影像学表现方面没有明显差异，年龄和性别均不是 CAP 死亡率的预测因素。
