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Clearer diagnoses in pneumonia care can aid in reducing unnecessary treatments and improve patient outcomes.
A study in the Annals of Internal Medicine found discrepancies between the initial diagnosis and discharge diagnosis of pneumonia in more than half of patients. Spread across 2.3 million hospitalizations, this national cohort study highlighted the widespread issue of diagnostic uncertainty, with numerous patients receiving treatments for conditions other than pneumonia and clinicians often expressing doubt in their notes.
Directed across 115 U.S. Veterans Affairs medical centers, Barbara E. Jones and researchers analyzed the evolution of pneumonia diagnoses in patients in the emergency department (ED) between Jan 2015 and Jan 2022. As discovered, 13.3% of patients were initially diagnosed with pneumonia, yet 57% of those had discordant diagnoses by discharge. In fact, a third of patients discharged with a pneumonia diagnosis had no initial diagnosis, and 36% initially diagnosed with pneumonia were not given this diagnosis upon discharge. The study also uncovered recurrent uncertainty expressed by healthcare professionals in clinical notes, particularly in the ED (58%) and at discharge (48%).
Diuretics (water pills), corticosteroids and antibiotic therapies were commonly administered, despite unclear final diagnosis. More concerningly, the patients with discordant diagnoses had higher 30-day mortality rates, especially those who were never diagnosed with pneumonia at admission. These patients had a 14.4% mortality rate, compared to just 10.6% for those with consistent diagnoses. Patients experiencing diagnostic inconsistencies were more likely to visit specialized facilities with a high volume of ED cases and high inpatient occupancy.
To sum up, more than half of pneumonia sufferers experienced diagnostic discordance from initial presentation to discharge, with common occurrences of treatments for alternative diagnoses and expressions of uncertainty during the care process. These findings emphasize the critical need to recognize diagnostic uncertainty to boost patient outcomes and guide more accurate therapeutic decisions.
Annals of Internal Medicine
Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals
Barbara E. Jones et al.
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