Bouam Maria, Binquet Christine, Moretto Florian, Sixt Thibault, Vourc'h Michèle, Piroth Lionel, Ray Patrick, Blot Mathieu
Emergency Department, Dijon-Bourgogne University Hospital, Dijon, France.
CHU Dijon-Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.
Front Med (Lausanne). 2023 May 12;10:1042704. doi: 10.3389/fmed.2023.1042704. eCollection 2023.
Whether a delayed diagnosis of community-acquired pneumonia (CAP) in the emergency department (ED) is associated with worse outcome is uncertain. We sought factors associated with a delayed diagnosis of CAP in the ED and those associated with in-hospital mortality.
Retrospective study including all inpatients admitted to an ED (Dijon University Hospital, France) from 1 January to 31 December 2019, and hospitalized with a diagnosis of CAP. Patients diagnosed with CAP in the ED ( = 361, early diagnosis) were compared with those diagnosed later, in the hospital ward, after the ED visit ( = 74, delayed diagnosis). Demographic, clinical, biological and radiological data were collected upon admission to the ED, as well as administered therapies and outcomes including in-hospital mortality.
435 inpatients were included: 361 (83%) with an early and 74 (17%) with a delayed diagnosis. The latter less frequently required oxygen (54 vs. 77%; < 0.001) and were less likely to have a quick-SOFA score ≥ 2 (20 vs. 32%; = 0.056). Absence of chronic neurocognitive disorders, of dyspnea, and of radiological signs of pneumonia were independently associated with a delayed diagnosis. Patients with a delayed diagnosis less frequently received antibiotics in the ED (34 vs. 75%; < 0.001). However, a delayed diagnosis was not associated with in-hospital mortality after adjusting on initial severity.
Delayed diagnosis of pneumonia was associated with a less severe clinical presentation, lack of obvious signs of pneumonia on chest X-ray, and delayed antibiotics initiation, but was not associated with worse outcome.
急诊科（ED）对社区获得性肺炎（CAP）的延迟诊断是否与更差的预后相关尚不确定。我们寻找与急诊科CAP延迟诊断相关的因素以及与院内死亡率相关的因素。
回顾性研究纳入了2019年1月1日至12月31日在法国第戎大学医院急诊科收治的所有住院患者，这些患者被诊断为CAP。将在急诊科被诊断为CAP的患者（n = 361，早期诊断）与在急诊科就诊后在医院病房中较晚被诊断的患者（n = 74，延迟诊断）进行比较。在患者入院至急诊科时收集人口统计学、临床、生物学和放射学数据，以及所给予的治疗和包括院内死亡率在内的结局。
共纳入435例住院患者：361例（83%）为早期诊断，74例（17%）为延迟诊断。延迟诊断的患者较少需要吸氧（54%对77%；P < 0.001），且快速序贯器官衰竭评估（quick-SOFA）评分≥2的可能性较小（20%对32%；P = 0.056）。无慢性神经认知障碍、无呼吸困难以及无肺炎的放射学征象与延迟诊断独立相关。延迟诊断的患者在急诊科较少接受抗生素治疗（34%对75%；P < 0.001）。然而，在对初始严重程度进行调整后，延迟诊断与院内死亡率无关。
肺炎的延迟诊断与临床表现较轻、胸部X线无明显肺炎征象以及抗生素起始延迟相关，但与更差的预后无关。
