Delayed diagnosis of pneumonia in the emergency department: factors associated and prognosis

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...

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Bibliographic Details
Published in:	Frontiers in medicine Vol. 10; p. 1042704
Main Authors:	Bouam, Maria, Binquet, Christine, Moretto, Florian, Sixt, Thibault, Vourc'h, Michèle, Piroth, Lionel, Ray, Patrick, Blot, Mathieu
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 12-05-2023
Subjects:	antibiotic therapy community-acquired pneumonia delayed diagnosis Medicine mortality outcomes pneumonia delayed diagnosis antibiotic therapy pneumonia outcomes mortality community-acquired pneumonia emergency department
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Longxiang Su, Peking Union Medical College Hospital (CAMS), China Reviewed by: Ornella Spagnolello, Sapienza University of Rome, Italy; Rabbani Syed, King Saud University, Saudi Arabia
ISSN:	2296-858X 2296-858X
DOI:	10.3389/fmed.2023.1042704