Patients admitted to hospital with suspected pneumonia and normal chest radiographs: Epidemiology, microbiology, and outcomes
Section snippets
Subjects and setting
Capital Health (Edmonton, Alberta) is considered one of the largest integrated health systems in Canada (14). It serves approximately 1 million people and has an annual health budget of almost 2 billion Canadian dollars (14). From November 15, 2000, to November 14, 2001, 2706 adults were admitted with a clinical diagnosis of pneumonia by 318 physicians to six regional hospitals (two tertiary care hospitals, two hospitals that provided secondary and some tertiary care, and two smaller community
Results
Over 1 year, a total of 2706 patients with clinically suspected community-acquired pneumonia were admitted to our hospitals and enrolled in the pneumonia pathway. Of these patients, 1795 (66%) had radiograph-confirmed pneumonia and 911 (34%) did not have radiographic confirmation of the disease. Only 53 patients (2%) in the cohort did not have at least one follow-up chest radiograph after admission (Figure).
Patients with unconfirmed pneumonia were older than those with radiograph-confirmed
Discussion
In a large prospective cohort of patients admitted to hospital with a clinical diagnosis of pneumonia, we found that one third of patients did not have radiographic confirmation of this diagnosis. In fact, of the chest radiographs read as “no pneumonia” by the radiologist, only 7% (6 of 92 sampled) had opacities consistent with pneumonia. Thus, by the currently accepted definition, 93% of these patients did not have pneumonia; rather, they most likely had a serious lower respiratory tract
Acknowledgment
We thank the Community-Acquired Pneumonia Pathway research nurses: JoAnne deJager, Linda Gardner, Lynne Korobanik, Tammy Pfeiffer, Cynthia Proskow, Sue Marshall, and Fredrika Herbert. We would also like to thank the staff of EPICORE for data management services.
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Cited by (0)
Supported by grants from the Alberta Heritage Foundation for Medical Research, Capital Health (Edmonton, Alberta), Abbott Canada, Janssen-Ortho Canada, and Pfizer Canada. Dr. Majumdar is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research and a New Investigator of the Canadian Institutes of Health Research.