Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes

Abstract

Background Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes. Objective We analyzed patient-level covariates associated with clinician-defined aspiration pneumonia. Methods We used the Community-Acquired Pneumonia Organization (CAPO) database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with non-aspiration pneumonia. Results We studied 5185 patients. 451 of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with non-aspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs. 13%, p=0.002), had longer unadjusted hospital length of stay (9 vs. 7 days, p<0.001), and took longer to achieve clinical stability (unadjusted 8 vs. 4 days, p<0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (OR 4.4, 2.9, 2.3 respectively). Unadjusted inpatient mortality was higher (23% vs. 9%, p < 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality, after adjusting for age, disease severity, and comorbidities. Conclusions Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration, Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment

“…[7][8][9][10][11]13 Further investigation is needed to explain how much these findings are a manifestation of aspiration pathophysiology versus an artifact 6 of making the diagnosis. For children truly experiencing aspiration, the penetration of oropharyngeal saliva or acidic gastric contents, along with enteric bacteria, into the airway can result in a higher severity of epithelial disruption, inflammation, impaired gas exchange, and prolonged healing than when the airway is exposed to exogenous bacteria alone.…”

“…Hospitalizations with a principal diagnosis of pneumonia (aspiration or nonaspiration) were identified with ICD-9-CM diagnosis codes based on previously used methods. 7,8,[10][11][12][13] Principal diagnosis is the condition established as chiefly responsible for hospital admission. 14 Aspiration pneumonia codes were 507.× (eg, "pneumonitis due to solids and liquids").…”

“…14 Aspiration pneumonia codes were 507.× (eg, "pneumonitis due to solids and liquids"). 7,8,10,11,13 12 For children with multiple hospitalizations (13% of sample), 1 admission was randomly selected for inclusion. This method helped prevent findings from being heavily influenced by a small group of children experiencing a large number of admission or by 1 type of admission (eg, readmissions).…”

Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients

“…67 Aspiration pneumonia from inhalation of oropharyngeal contents occurs in 5-15% of patients diagnosed with pneumonia and carries an increased mortality risk of 15-21%. 16,68,69 Respiratory compromise from aspiration pneumonia presents as tachypnea, cough, fever or hypothermia, tachycardia, hypocarbia, and hypoxemia. Changes in breath sounds are dependent on patient position at the time of aspiration: If recumbent, decreased breath sounds and/or rales may be heard in the posterior upper lobes and apical segments of the lower lobes; if semi-recumbent or upright, altered auscultation findings are likely to be heard in the basal segments of the lower lobes.…”

Neumonía adquirida en la comunidad

“…Capítulo aparte merece la neumonía aspirativa que, como su nombre indica, precisa la existencia de unos factores favorecedores en su desarrollo, perfectamente establecidos desde hace décadas; a saber, el alcoholismo, las enfermedades neurológicas o gastrointestinales que dificultan el tránsito intestinal alto y las condiciones que suponen un descenso del nivel de conciencia 14 .…”