Pneumonia Diagnosis Agreement Between Treating Emergency Physicians and Adjudicators in Older Adult Emergency...

Although important for optimizing outcomes, differentiating pneumonia from other pulmonary conditions may be difficult in older patients. We sought to determine the accuracy of emergency physician identification of pneumonia in older emergency department (ED) patients.

This was a preplanned secondary analysis of a prospective, observational study of older adult ED patients with suspected pneumonia. The gold standard pneumonia diagnosis was consensus classification by trained chart adjudicators. The primary objective was to compare treating emergency physician vs adjudicator pneumonia diagnosis. The secondary objective was to determine the presence of information leading to adjudicator classification to emergency physicians and the frequency of emergency physician descriptions of diagnostic uncertainty in notes.

Agreement on the presence or absence of pneumonia between the adjudicators and treating emergency physicians was 51.5% (95% CI, 42.9%-60.1%) and kappa was 0.26 (95% CI, 0.18-0.30). Notably, the largest proportion of disagreements were diagnosed as "unclear" by the treating emergency physician. The minority of patient charts had attending or resident physician documentation expressing uncertainty in the diagnosis (28.5%; 95% CI, 21.3%-36.9%). In most cases (80.0%; 95% CI, 72.2%-86.1%), clinical information pivotal to adjudicator classification was also available to clinicians.

Disagreement on pneumonia diagnosis between adjudicators and treating emergency physicians was high. However, adjudicators reported that the data to make the final diagnosis were frequently present during the ED visit, suggesting that diagnostic tools could assist emergency physicians.