Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
College of Nursing, The Ohio State University, Columbus, Ohio, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3068-3077. doi: 10.1111/jgs.19113. Epub 2024 Aug 24.
Pneumonia accounts for over half a million older adult emergency department (ED) visits annually, but ED pneumonia diagnosis is inaccurate. Geriatric-specific pneumonia diagnostic criteria exist for other settings; no prospective data exist to determine if application in the older adult ED population is feasible. The objective was to prospectively evaluate the utility of four current diagnostic criteria (Loeb; Modified McGeer; Infectious Disease Society of America/American Thoracic Society; American College of Emergency Physicians) in older adult ED patients.
This was a prospective, observational cohort study of older adult ED patients ≥65 years of age in two U.S. EDs with suspected pneumonia defined as having chest radiography ordered and treating physician suspicion. The standard we used for defining the presence, absence, or inability to determine a diagnosis of pneumonia diagnosis was expert physician chart adjudication. We report the summary statistics for demographic characteristics and symptoms/exam findings and sensitivity, specificity, and likelihood ratios with 95% confidence intervals of the existing diagnostic criteria. Pre-specified cutoff values of a positive LR >10 and a negative LR <0.3 were considered clinically significant.
Of 135 patients enrolled, 27 had pneumonia by adjudicator review. Typical patient-reported pneumonia symptoms, such as fever (18.5%) and new/worse cough (51.9%), were not consistently present in pneumonia. The IDSA/ATS and ACEP criteria had positive LR >10 and negative LR <0.3; however, all confidence intervals included pre-specified cutoffs.
Older adults presented to the ED with low frequency of typical pneumonia symptoms. Although existing diagnostic definitions had promising test characteristics, they may not perform well enough for clinical application without refinement.
肺炎每年导致超过 50 万老年人前往急诊部（ED）就诊，但 ED 肺炎的诊断并不准确。针对其他情况，存在特定于老年人群的肺炎诊断标准；但尚无前瞻性数据来确定这些标准在老年 ED 人群中的应用是否可行。本研究的目的是前瞻性评估四种当前诊断标准（Loeb 标准、改良 McGeer 标准、美国传染病学会/美国胸科学会标准、美国急诊医师学会标准）在老年 ED 患者中的应用价值。
这是一项在美国两家 ED 进行的前瞻性观察性队列研究，纳入年龄≥65 岁、疑似肺炎的老年 ED 患者，定义为胸部 X 线检查和治疗医师怀疑存在肺炎。我们使用专家医师对病历进行审查来定义肺炎的存在、不存在或无法确定诊断，作为肺炎诊断的标准。我们报告了人口统计学特征和症状/检查结果的摘要统计数据，以及现有诊断标准的敏感性、特异性和比值比及其 95%置信区间。阳性似然比（LR）>10 和阴性 LR <0.3 的预设定截断值被认为具有临床意义。
在纳入的 135 例患者中，有 27 例经判定员审查被诊断为肺炎。典型的患者报告的肺炎症状，如发热（18.5%）和新发/加重咳嗽（51.9%），并不总是出现在肺炎患者中。IDSA/ATS 和 ACEP 标准的阳性 LR >10，阴性 LR <0.3；然而，所有置信区间均包含预设定的截断值。
老年人因肺炎前往 ED 的频率较低，且典型肺炎症状的发生率较低。尽管现有的诊断定义具有有前景的试验特征，但如果不加以改进，它们可能无法满足临床应用的要求。
