A study released Monday found that it’s common for people hospitalized for community-acquired pneumonia (CAP) to be inappropriately diagnosed with the condition — especially people who are older, have dementia or experience an altered mental state.
The study, which was published in JAMA Internal Medicine, evaluated the inappropriate diagnosis of CAP in 17,290 people hospitalized from 48 hospitals in Michigan. The people were treated for pneumonia between 2017 and 2020. All of them were admitted to the hospital with a pneumonia diagnosis, and received antibiotics on their first or second day in the hospital.
Researchers analyzed which people were correctly treated by quantifying signs and symptoms as well as chest imaging. The team looked at 30-day outcomes including adverse events from medication, readmission and death. Of the people hospitalized for pneumonia and treated for it, 125 met the criteria for an inappropriate diagnosis. The median age was 71.8 and just over half were women.
Compared to people with CAP, those inappropriately diagnosed were older, more likely to have dementia or more apt to have an altered mental status. Outcomes for full compared to brief treatment didn’t differ much, but full antibiotic treatment compared to brief treatment was linked with adverse effects in 2.1% and 0.4% of people, respectively. (A full course was defined as taking antibiotics for more than three days.)
“While some inappropriate diagnosis of CAP is unavoidable due to diagnostic uncertainty when patients are first hospitalized, many patients remain inappropriately diagnosed even on hospital discharge,” the authors wrote.
The authors said that the risks of inaccurate diagnosis vary between populations. The vulnerable groups most likely to be inappropriately diagnosed are the same that are likely to be affected by antibiotic-associated adverse events. That’s why balancing the harms of underdiagnosis and overdiagnosis of CAP is so critical, the authors noted.
