在住院成年人中不适当诊断肺炎
Ashwin B Gupta1,2, Scott A Flanders2, Lindsay A Petty3
1Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
JAMA internal medicine
|March 25, 2024
概括
社区获得性肺炎 (CAP) 的错误诊断在住院成年人中很常见. 对这些患者进行全程抗生素治疗可能会增加不良事件的风险.
科学领域:
- 传染性疾病 传染性疾病
- 临床医学 临床医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在住院患者中,社区获得性肺炎 (CAP) 的诊断和治疗是常见的.
- 人们对不适当的CAP诊断的发生率,危险因素和危害知之甚少.
研究的目的:
- 在住院患者中对CAP的不适当诊断的特征.
- 识别与不适当的CAP诊断相关的风险因素.
- 评估不适当诊断的CAP患者的30天结果.
主要方法:
- 在密歇根州48家医院进行前性队列研究.
- 包括2017年7月至2020年3月期间接受CAP治疗的住院成年人.
- 使用国家质量论坛标准 (抗生素治疗<2个症状或阴性胸部成像) 定义不合适的CAP诊断.
主要成果:
- 在17290名患者中,有12.0%的患者接受了不适当的CAP诊断.
- 错误诊断的患者年龄较大,患有痴呆症或精神状态改变.
- 在不恰当诊断的患者中,30天复合结果在全 (>3天) 和短 (≤3天) 抗生素疗程之间没有差异.
结论:
- 不适当的CAP诊断在住院成年人中普遍存在,特别是老年人和认知障碍患者.
- 对不适当诊断的CAP进行全程抗生素治疗可能与抗生素相关的不良事件增加有关.
- 需要进一步的研究来优化CAP诊断和抗生素管理.
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