Prevalence of Clinical Signs Within Reference Ranges Among Hospitalized Patients Prescribed Antibiotics for Pneumonia

Ochoa, Aileen; Ji, Wenjing; McKenna, Caroline; Clark, Roger; Shenoy, Erica S.; Hooper, David C.; Rhee, Chanu

doi:10.1001/jamanetworkopen.2020.10700

Cited by 10 publications

(5 citation statements)

References 44 publications

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“…8 • In a multicenter cohort of 12,273 hospitalized patients treated for possible community-or hospital-acquired pneumoniamany of whom had positive sputum cultures-2,149 (17.5%) had no cardinal signs of pneumonia at the time of diagnosis. 9 Our institutional experience similarly reveals a high prevalence of pneumonia misdiagnosis. We retrospectively reviewed the management of a cohort of hospitalized patients with positive respiratory cultures who were presumptively treated for bacterial pneumonia.…”

mentioning

confidence: 64%

Asymptomatic bacterisputia: Rethinking diagnostic stewardship in pneumonia

Albin

Pogue

Petty

et al. 2021

Infect. Control Hosp. Epidemiol.

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mentioning

confidence: 64%

Asymptomatic bacterisputia: Rethinking diagnostic stewardship in pneumonia

Albin

Pogue

Petty

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…To convert white blood cell count to ×10 between reviewers, correspond variably with histology, and clinical audits suggest that a third or more of patients treated for NV-HAP do not have pneumonia. [40][41][42][43][44] Discharge diagnosis codes also do not provide reliable estimates of NV-HAP incidence and outcomes because they too are neither sensitive nor specific. 10,11 Even cases identified using formal CDC criteria are inconsistently confirmed on external review.…”

Section: Discussionmentioning

confidence: 99%

“…Microbiologic confirmation of infection occurs in fewer than half of patients who undergo cultures . Clinical and radiographic interpretations vary between reviewers, correspond variably with histology, and clinical audits suggest that a third or more of patients treated for NV-HAP do not have pneumonia …”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Non–Ventilator-Associated Hospital-Acquired Pneumonia in 284 US Hospitals Using Electronic Surveillance Criteria

Jones,

Sarvet,

Ying

et al. 2023

JAMA Netw Open

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ImportanceNon–ventilator-associated hospital-acquired pneumonia (NV-HAP) is a common and deadly hospital-acquired infection. However, inconsistent surveillance methods and unclear estimates of attributable mortality challenge prevention.ObjectiveTo estimate the incidence, variability, outcomes, and population attributable mortality of NV-HAP.Design, Setting, and ParticipantsThis cohort study retrospectively applied clinical surveillance criteria for NV-HAP to electronic health record data from 284 US hospitals. Adult patients admitted to the Veterans Health Administration hospital from 2015 to 2020 and HCA Healthcare hospitals from 2018 to 2020 were included. The medical records of 250 patients who met the surveillance criteria were reviewed for accuracy.ExposuresNV-HAP, defined as sustained deterioration in oxygenation for 2 or more days in a patient who was not ventilated concurrent with abnormal temperature or white blood cell count, performance of chest imaging, and 3 or more days of new antibiotics.Main Outcomes and MeasuresNV-HAP incidence, length-of-stay, and crude inpatient mortality. Attributable inpatient mortality by 60 days follow-up was estimated using inverse probability weighting, accounting for both baseline and time-varying confounding.ResultsAmong 6 022 185 hospitalizations (median [IQR] age, 66 [54-75] years; 1 829 475 [26.1%] female), there were 32 797 NV-HAP events (0.55 per 100 admissions [95% CI, 0.54-0.55] per 100 admissions and 0.96 per 1000 patient-days [95% CI, 0.95-0.97] per 1000 patient-days). Patients with NV-HAP had multiple comorbidities (median [IQR], 6 [4-7]), including congestive heart failure (9680 [29.5%]), neurologic conditions (8255 [25.2%]), chronic lung disease (6439 [19.6%]), and cancer (5,467 [16.7%]); 24 568 cases (74.9%) occurred outside intensive care units. Crude inpatient mortality was 22.4% (7361 of 32 797) for NV-HAP vs 1.9% (115 530 of 6 022 185) for all hospitalizations; 12 449 (8.0%) were discharged to hospice. Median [IQR] length-of-stay was 16 (11-26) days vs 4 (3-6) days. On medical record review, pneumonia was confirmed by reviewers or bedside clinicians in 202 of 250 patients (81%). It was estimated that NV-HAP accounted for 7.3% (95% CI, 7.1%-7.5%) of all hospital deaths (total hospital population inpatient death risk of 1.87% with NV-HAP events included vs 1.73% with NV-HAP events excluded; risk ratio, 0.927; 95% CI, 0.925-0.929).Conclusions and RelevanceIn this cohort study, NV-HAP, which was defined using electronic surveillance criteria, was present in approximately 1 in 200 hospitalizations, of whom 1 in 5 died in the hospital. NV-HAP may account for up to 7% of all hospital deaths. These findings underscore the need to systematically monitor NV-HAP, define best practices for prevention, and track their impact.

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“…As with body temperature, the definition of the lowest value for normal oxygen saturation also varies; 90% 45 , 95% 46 , 94% 47 , 96% 48 , 97% 49 . Reference ranges for normal oxygen saturation are known to be lower in individuals living at high altitude, < 90% 50,51 , i.e.…”

Section: Assessment Of Changes In Body Temperature and Oxygen Saturationmentioning

confidence: 99%

Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine

Sund

Hagman²,

Grodzinsky

2023

MRAJ

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Background: Precision medicine aims to provide patients with care and treatment based on the individual's unique conditions. Current reference ranges for vital parameters are based on healthy reference populations at group level, usually male, individuals excluding long-term medical conditions and daily medication. This entails a risk of misinterpretation on each measurement occasion because a deviant value for the individual may be camouflaged by a normal value at group level. We believe that precision medicine in practice requires that values for vital parameters are interpreted in relation to the individual's normal range in habitual condition. Aim: To investigate body temperature and oxygen saturation in healthy and frail individuals, based on individual normal range in habitual condition. Methods: The sample consisted of 70 healthy individuals, 27 to 80y, 20 nursing home residents, 70 to 100y, and 32 patients in hospital-affiliated home care, 60 to 95y. Age, gender, physical ability, chronic disease, medication was documented. Ear temperature and oxygen saturation were performed for five mornings before getting out of bed and taking medicine, food or drink. Results: The range for body temperature in healthy subjects was 34.3°C to 37.7 °C and in frail elderly 34.5°C to 37.7 °C. No differences in the variation of normal range in body temperature was found between healthy and frail individuals, 0.7°C + 0.4°C, though the variation between min and max temperature were large; 2.4°C vs 2.7°C and 2.9°C vs 2.3°C in healthy and frail subjects, respectively. A max temperature of < 36.2°C was more frequent in healthy subjects. The range for oxygen saturation varied between 85% to 99%, in healthy subjects and 75% to 100% in frail elderly. No healthy subjects had a max oxygen saturation value <94%. Inflammatory processes influenced body temperature and oxygen saturation in frail elderly. Conclusion: To promote precision medicine and health our results show that it is necessary to interpret body temperature and oxygen saturation based on individual normal ranges in habitual condition. By interpreting deviations from the individual's normal interval, the possibility of necessary care efforts increases without delay, which can be decisive before further deterioration.

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Prevalence of Clinical Signs Within Reference Ranges Among Hospitalized Patients Prescribed Antibiotics for Pneumonia

Cited by 10 publications

References 44 publications

Asymptomatic bacterisputia: Rethinking diagnostic stewardship in pneumonia

Asymptomatic bacterisputia: Rethinking diagnostic stewardship in pneumonia

Incidence and Outcomes of Non–Ventilator-Associated Hospital-Acquired Pneumonia in 284 US Hospitals Using Electronic Surveillance Criteria

Interpretation of Body Temperature and Oxygen Saturation based on Individual Normal Ranges in Habitual Condition: A Step Forward for Applied Precision Medicine

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