Hunold Katherine M, Gure Tanya R, Schwaderer Andrew L, Exline Matthew, Hebert Courtney, Lampert Brent C, Southerland Lauren T, Stephens Julie A, Boyer Edward W, Hill Michael, Chu Ching-Min B, Mion Lorraine C, Caterino Jeffrey M
Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
Division of General Internal Medicine and Geriatrics, The Ohio State University, Columbus, Ohio, USA.
J Am Coll Emerg Physicians Open. 2025 Jun 19;6(4):100205. doi: 10.1016/j.acepjo.2025.100205. eCollection 2025 Aug.
Although important for optimizing outcomes, differentiating pneumonia from other pulmonary conditions may be difficult in older patients. We sought to determine the accuracy of emergency physician identification of pneumonia in older emergency department (ED) patients.
This was a preplanned secondary analysis of a prospective, observational study of older adult ED patients with suspected pneumonia. The gold standard pneumonia diagnosis was consensus classification by trained chart adjudicators. The primary objective was to compare treating emergency physician vs adjudicator pneumonia diagnosis. The secondary objective was to determine the presence of information leading to adjudicator classification to emergency physicians and the frequency of emergency physician descriptions of diagnostic uncertainty in notes.
Agreement on the presence or absence of pneumonia between the adjudicators and treating emergency physicians was 51.5% (95% CI, 42.9%-60.1%) and kappa was 0.26 (95% CI, 0.18-0.30). Notably, the largest proportion of disagreements were diagnosed as "unclear" by the treating emergency physician. The minority of patient charts had attending or resident physician documentation expressing uncertainty in the diagnosis (28.5%; 95% CI, 21.3%-36.9%). In most cases (80.0%; 95% CI, 72.2%-86.1%), clinical information pivotal to adjudicator classification was also available to clinicians.
Disagreement on pneumonia diagnosis between adjudicators and treating emergency physicians was high. However, adjudicators reported that the data to make the final diagnosis were frequently present during the ED visit, suggesting that diagnostic tools could assist emergency physicians.
尽管区分肺炎与其他肺部疾病对于优化治疗结果很重要，但在老年患者中可能很难做到。我们试图确定急诊医生对老年急诊科患者肺炎诊断的准确性。
这是一项对疑似肺炎的老年急诊科患者进行的前瞻性观察研究的预先计划的二次分析。肺炎的金标准诊断是由经过培训的图表评审员进行的共识分类。主要目的是比较主治急诊医生与评审员对肺炎的诊断。次要目的是确定导致评审员进行分类的信息是否提供给了急诊医生，以及急诊医生在病历中描述诊断不确定性的频率。
评审员与主治急诊医生在是否存在肺炎方面的一致性为51.5%（95%CI，42.9%-60.1%），kappa值为0.26（95%CI，0.18-0.30）。值得注意的是，最大比例的分歧被主治急诊医生诊断为“不明确”。少数患者病历中有主治医生或住院医生记录表达了对诊断的不确定性（28.5%；95%CI，21.3%-36.9%）。在大多数情况下（80.0%；95%CI，72.2%-86.1%），评审员进行分类所关键的临床信息临床医生也可以获得。
评审员与主治急诊医生在肺炎诊断上的分歧很大。然而，评审员报告说，做出最终诊断的数据在急诊就诊期间经常存在，这表明诊断工具可以帮助急诊医生。
