Hospital-acquired pneumonia incidence and diagnosis in older patients

Louise A. Burton, Rosemary Price, Karen E. Barr, Sean M. McAuley, Jennifer B. Allen, Aoibhinn M. Clinton, Gabby Phillips, Charis A. Marwick, Marion E. T. McMurdo, Miles D. Witham (Lead / Corresponding author)

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    Abstract

    BACKGROUND: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people.

    METHODS: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP.

    RESULTS: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41%) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9% of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8% of admissions). The risk of HAP was 0.3% per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47%) of cases lacked evidence in two or more domains.

    CONCLUSION: HAP is common but over-diagnosed in older hospitalised patients.

    Original languageEnglish
    Pages (from-to)171-174
    Number of pages4
    JournalAge and Ageing
    Volume45
    Issue number1
    Early online date18 Dec 2015
    DOIs
    Publication statusPublished - Jan 2016

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    Pneumonia
    Incidence
    Length of Stay
    Respiratory Signs and Symptoms
    Patient Admission
    Orthopedics
    Patient Care
    Medicine
    Inflammation

    Keywords

    • older
    • Diagnosis
    • hospital-acquired pneumonia
    • Incidence

    Cite this

    Burton, L. A., Price, R., Barr, K. E., McAuley, S. M., Allen, J. B., Clinton, A. M., ... Witham, M. D. (2016). Hospital-acquired pneumonia incidence and diagnosis in older patients. Age and Ageing, 45(1), 171-174. https://doi.org/10.1093/ageing/afv168
    Burton, Louise A. ; Price, Rosemary ; Barr, Karen E. ; McAuley, Sean M. ; Allen, Jennifer B. ; Clinton, Aoibhinn M. ; Phillips, Gabby ; Marwick, Charis A. ; McMurdo, Marion E. T. ; Witham, Miles D. / Hospital-acquired pneumonia incidence and diagnosis in older patients. In: Age and Ageing. 2016 ; Vol. 45, No. 1. pp. 171-174.
    @article{5719ebccfff342edad57c7366c650ec4,
    title = "Hospital-acquired pneumonia incidence and diagnosis in older patients",
    abstract = "BACKGROUND: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people.METHODS: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP.RESULTS: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41{\%}) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9{\%} of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8{\%} of admissions). The risk of HAP was 0.3{\%} per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47{\%}) of cases lacked evidence in two or more domains.CONCLUSION: HAP is common but over-diagnosed in older hospitalised patients.",
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    Burton, LA, Price, R, Barr, KE, McAuley, SM, Allen, JB, Clinton, AM, Phillips, G, Marwick, CA, McMurdo, MET & Witham, MD 2016, 'Hospital-acquired pneumonia incidence and diagnosis in older patients', Age and Ageing, vol. 45, no. 1, pp. 171-174. https://doi.org/10.1093/ageing/afv168

    Hospital-acquired pneumonia incidence and diagnosis in older patients. / Burton, Louise A.; Price, Rosemary ; Barr, Karen E.; McAuley, Sean M.; Allen, Jennifer B.; Clinton, Aoibhinn M.; Phillips, Gabby; Marwick, Charis A.; McMurdo, Marion E. T.; Witham, Miles D. (Lead / Corresponding author).

    In: Age and Ageing, Vol. 45, No. 1, 01.2016, p. 171-174.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Hospital-acquired pneumonia incidence and diagnosis in older patients

    AU - Burton, Louise A.

    AU - Price, Rosemary

    AU - Barr, Karen E.

    AU - McAuley, Sean M.

    AU - Allen, Jennifer B.

    AU - Clinton, Aoibhinn M.

    AU - Phillips, Gabby

    AU - Marwick, Charis A.

    AU - McMurdo, Marion E. T.

    AU - Witham, Miles D.

    N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

    PY - 2016/1

    Y1 - 2016/1

    N2 - BACKGROUND: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people.METHODS: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP.RESULTS: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41%) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9% of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8% of admissions). The risk of HAP was 0.3% per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47%) of cases lacked evidence in two or more domains.CONCLUSION: HAP is common but over-diagnosed in older hospitalised patients.

    AB - BACKGROUND: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people.METHODS: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP.RESULTS: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41%) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9% of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8% of admissions). The risk of HAP was 0.3% per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47%) of cases lacked evidence in two or more domains.CONCLUSION: HAP is common but over-diagnosed in older hospitalised patients.

    KW - older

    KW - Diagnosis

    KW - hospital-acquired pneumonia

    KW - Incidence

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    Burton LA, Price R, Barr KE, McAuley SM, Allen JB, Clinton AM et al. Hospital-acquired pneumonia incidence and diagnosis in older patients. Age and Ageing. 2016 Jan;45(1):171-174. https://doi.org/10.1093/ageing/afv168