Cohort Study: Inappropriate pneumonia diagnoses and associated risks in 17,290 hospitalized adults

Study Design and Population:

This prospective cohort study analyzed medical records and patient interactions from July 2017 to March 2020 across 48 Michigan hospitals. A total of 17,290 adults admitted for general care were retrospectively assessed for community-acquired pneumonia (CAP) treatment, focusing on those who received antibiotics within the first two days of hospitalization.

Main Findings:

The study identified that 12.0% of the patients were inappropriately diagnosed with CAP. Key risk factors for misdiagnosis included older age, presence of dementia, and altered mental status at presentation. Among those misdiagnosed, 87.6% underwent a full course of antibiotics, which did not significantly change the 30-day risk of mortality, readmission, emergency visits, or Clostridioides difficile infections compared to brief treatment but was associated with higher antibiotic-related adverse events.

Implications for Practice:

The findings underscore the prevalence of inappropriate pneumonia diagnosis among hospitalized adults, especially in older patients with specific geriatric conditions. This study highlights the potential harms of unnecessary antibiotic use, suggesting a need for improved diagnostic accuracy and treatment decision-making in hospital settings to mitigate adverse outcomes.

Reference (free full-text):

Gupta, A. B. et al. (2024). Inappropriate Diagnosis of Pneumonia Among Hospitalized Adults. JAMA Intern Med. Published online March 25, 2024. DOI: 10.1001/jamainternmed.2024.0077.