Inappropriate pneumonia diagnosis common, potentially harmful for hospitalized older adults

For the study, researchers reviewed the medical records of 17,290 hospitalized patients treated for CAP. These patients were followed up with a 30-day postdischarge telephone call to monitor events.

Risk factors for inappropriate diagnosis were evaluated, as were the 30-day composite outcomes (mortality, readmission, emergency department visit, Clostridioides difficile infection, and antibiotic-associated adverse events). Inappropriate CAP diagnosis was defined using a National Quality Forum–endorsed metric as CAP-directed antibiotic therapy in patients with fewer than two signs or symptoms of CAP or negative chest imaging.

A total of 2,079 patients (12.0 percent; median age 71.8 years, 50.3 percent female) met the criteria for inappropriate CAP diagnosis, of whom 1,821 (87.6 percent) received full antibiotic courses. Patients who received an inappropriate versus appropriate CAP diagnosis tended to be older (adjusted odds ratio [AOR], 1.08 per decade, 95 percent confidence interval [CI], 1.05–1.11), have dementia (AOR, 1.79, 95 percent CI, 1.55–2.08), or have altered mental status on presentation (AOR, 1.75, 95 percent CI, 1.39–2.19).

Among patients with inappropriately diagnosed CAP, full antibiotic treatment led to 30-day composite outcomes that were similar to those observed with brief antibiotic treatment (25.8 percent vs 25.6 percent; AOR, 0.98, 95 percent CI, 0.79–1.23). However, a full duration of antibiotic treatment was associated with a significantly higher frequency of antibiotic-associated adverse events (2.1 percent vs 0.4 percent; p=0.03).