Table 3. Characteristics of Patients Treated for Community-Acquired Pneumonia (CAP) by Appropriateness of Diagnosis, Bivariable Analysis.
| Characteristic | No. (%) | P value | ||
|---|---|---|---|---|
| Total (N = 17 290) | Meeting criteria for CAP (n = 15 211) | Inappropriate diagnosis of CAP (n = 2079) | ||
| Age, y | ||||
| Median (IQR) | 69.8 (58.2-80.8) | 69.5 (57.9-80.6) | 71.8 (60.1-82.8) | <.001 |
| <65 | 6805 (39.4) | 6090 (40.0) | 715 (34.4) | <.001 |
| 65-74 | 3853 (22.3) | 3390 (22.3) | 463 (22.3) | |
| ≥75 | 6632 (38.4) | 5731 (37.7) | 901 (43.3) | |
| BMI, median (IQR) | 27.45 (23.12-33.15) | 27.46 (23.12-33.20) | 27.33 (23.10-32.81) | .26 |
| Sex | .95 | |||
| Female | 8679 (50.2) | 7634 (50.2) | 1045 (50.3) | |
| Male | 8611 (49.8) | 7577 (49.8) | 1034 (49.7) | |
| Race | .16 | |||
| Black | 3612 (21.0) | 3144 (20.7) | 468 (22.6) | |
| White | 13 008 (75.5) | 11 474 (75.7) | 1534 (74.0) | |
| Othera | 610 (3.5) | 539 (3.6) | 71 (3.4) | |
| Ethnicity | .08 | |||
| Hispanic | 299 (1.7) | 253 (1.7) | 46 (2.2) | |
| Non-Hispanic | 14 101 (81.6) | 12 435 (81.8) | 1666 (80.1) | |
| Unknown | 2890 (16.7) | 2523 (16.6) | 367 (17.7) | |
| Insurance type | .01 | |||
| Commercial | 4998 (29.9) | 4438 (30.2) | 560 (27.7) | |
| Public | 11 462 (68.6) | 10 019 (68.2) | 1443 (71.3) | |
| Self-pay | 252 (1.5) | 230 (1.6) | 22 (1.1) | |
| Pneumonia Severity Index, median (IQR) | 97.4 (74.2-122.6) | 97.6 (74.1-123.2) | 96.0 (74.4-119.3) | .03 |
| qSOFA score | ||||
| Mean (SD) | 0.80 (0.61) | 0.81 (0.61) | 0.72 (0.64) | <.001 |
| ≥2 | 1670 (9.7) | 1480 (9.7) | 190 (9.1) | .39 |
| <2 | 15 620 (90.3) | 13 731 (90.3) | 1889 (90.9) | |
| SIRS criteria ≥2 and end organ dysfunction | 5821 (33.7) | 5214 (34.3) | 607 (29.2) | <.001 |
| CHF exacerbation | 1403 (8.1) | 1251 (8.2) | 152 (7.3) | .15 |
| COPD exacerbation | 4316 (25.0) | 3764 (24.7) | 552 (26.6) | .07 |
| Altered mental status | 1303 (7.5) | 1080 (7.1) | 223 (10.7) | <.001 |
| Altered mental status without dementia | 867 (5.0) | 733 (4.8) | 134 (6.4) | .001 |
| Comorbidities | ||||
| Charlson Comorbidity Index, median (IQR) | 3.0 (1.0-4.0) | 3.0 (1.0-5.0) | 3.0 (1.0-4.0) | .08 |
| Influenza | 611 (3.5) | 544 (3.6) | 67 (3.2) | .41 |
| CHF | 4704 (27.2) | 4162 (27.4) | 542 (26.1) | .21 |
| COPD | 7606 (44.0) | 6702 (44.1) | 904 (43.5) | .62 |
| Diabetes | 5276 (30.5) | 4602 (30.3) | 674 (32.4) | .04 |
| Dementia | 1725 (10.0) | 1396 (9.2) | 329 (15.8) | <.001 |
| Chronic kidney disease | 4960 (28.7) | 4399 (28.9) | 561 (27.0) | .07 |
| Any cancerb | 3988 (23.1) | 3552 (23.4) | 436 (21.0) | .02 |
| Lung cancer | 925 (5.3) | 846 (5.6) | 79 (3.8) | <.001 |
| Current or former smoker | 11 467 (66.3) | 10 136 (66.6) | 1331 (64.0) | .02 |
| Home oxygen | 2747 (15.9) | 2446 (16.1) | 301 (14.5) | .06 |
| Immunosuppressionc | 1188 (6.9) | 1072 (7.0) | 116 (5.6) | .01 |
| History of MRSA infection | 50 (0.3) | 45 (0.3) | 5 (0.2) | .66 |
| Procalcitonin obtained | 4165 (24.1) | 3728 (24.5) | 437 (21.0) | <.001 |
| Procalcitonin range, ng/mLd | .01 | |||
| 0-0.1 | 1726 (41.4) | 1514 (40.6) | 212 (48.5) | |
| >0.1-0.25 | 879 (21.1) | 790 (21.2) | 89 (20.4) | |
| >0.25-0.5 | 532 (12.8) | 484 (13.0) | 48 (11.0) | |
| >0.5 | 1028 (24.7) | 940 (25.2) | 88 (20.1) | |
| Respiratory panele | <.001 | |||
| Positive | 571 (3.3) | 524 (3.4) | 47 (2.3) | |
| Negative | 2926 (16.9) | 2635 (17.3) | 291 (14.0) | |
| No test/missing | 13 793 (79.8) | 12 052 (79.2) | 1741 (83.7) | |
| Antibiotics within the past 90 d | 3817 (22.1) | 3352 (22.0) | 465 (22.4) | .73 |
| Hospital admission in prior 90 d | 4118 (23.8) | 3583 (23.6) | 535 (25.7) | .03 |
| Admitted from outside skilled nursing facility | 591 (3.4) | 505 (3.3) | 86 (4.1) | .055 |
| Admission from home and discharged to outside skilled nursing facility | 1774 (10.3) | 1523 (10.0) | 251 (12.1) | .004 |
| Functional status on admission | ||||
| Bedridden | 430 (2.5) | 348 (2.3) | 82 (3.9) | <.001 |
| Wheelchair bound | 746 (4.3) | 635 (4.2) | 111 (5.3) | .01 |
| Discharged to outside facility | 3157 (18.3) | 2687 (17.7) | 470 (22.6) | <.001 |
| Skilled nursing facility | 1745 (10.1) | 1453 (9.6) | 292 (14.0) | <.001 |
| Subacute rehabilitation | 718 (4.2) | 638 (4.2) | 80 (3.8) | .46 |
| Long-term care facility | 45 (0.3) | 40 (0.3) | 5 (0.2) | .85 |
| Acute rehabilitation facility | 103 (0.6) | 86 (0.6) | 17 (0.8) | .16 |
| Antibiotic duration, median (IQR), d | ||||
| Total duration | 7 (6-9) | 7 (6-9) | 7 (5-9) | <.001 |
| Inpatient duration | 4 (3-5) | 4 (3-5) | 4 (3-5) | <.001 |
| Discharge duration | 3 (0-5) | 3 (0-5) | 3 (0-5) | <.001 |
| Length of stay, median (IQR), d | 5 (4-6) | 5 (4-6) | 4 (3-6) | .23 |
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; MRSA, methicillin-resistant Staphylococcus aureus; qSOFA, quick Sequential Organ Failure Assessment; SIRS, systemic inflammatory response syndrome.
Due to the volume of cases, the Michigan Hospital Medicine Safety Consortium reports Black, White, and Other. Other includes the following categories: American Indian or Alaska Native, Arab or Chaldean ancestries, Asian, Native Hawaiian or Pacific Islander, and other (indicating that the patient is a race other than what is listed). A definition of how the Michigan Hospital Medicine Safety Consortium captures race information is included in the eAppendix in Supplement 1.
Any cancer includes, but is not limited to, malignant brain tumors, hematologic cancers, lymphoma, leukemia, lung cancer (small cell or non–small cell), ovarian cancer, colon cancer, prostate cancer, stomach/gastric cancer, pancreas/pancreatic cancer, kidney cancer, breast cancer, rectal/rectum cancer, bladder cancer, melanoma, liver cancer, uterine cancer, and metastatic cancer. This category does not include basal cell carcinoma, nonmelanoma skin cancer, squamous cell skin cancer, and inflammatory myofibroblastic pseudotumor without mention of cancer.
Immunosuppression includes chemotherapy administered within 30 days, HIV positive with a CD4 count greater than 200 cells/mm3, receiving a prednisone dose of 10 mg/d or more for at least 30 days (or equivalent corticosteroid dose), receiving biologic agents (eg, tumor necrosis factor inhibitors or other immunosuppressant agents), or congenital or acquired immunodeficiency.
Among those in whom procalcitonin testing was obtained.
Includes human metapneumovirus polymerase chain reaction, respiratory syncytial virus polymerase chain reaction or nucleic acid amplification, comprehensive viral respiratory screen, parainfluenza polymerase chain reaction, COVID-19 polymerase chain reaction, human rhinovirus/enterovirus polymerase chain reaction, and adenovirus polymerase chain reaction. Excludes influenza.