Document Detail

Mortality reduction among pneumonia patients still substantial despite the impact of coding changes.
MedLine Citation:
PMID:  23410567     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Accounting for changes in coding practices may be important in analyzing trends based on administrative data. Several studies have demonstrated large reductions in mortality over time among pneumonia patients. However, a recent study suggested that this reduction may have been an artifact of case definition because more of the highest-risk patients were being coded under alternative principal diagnoses in recent years.
METHODS: Using the National Inpatient Sample from 1993 to 2005, we selected hospitalizations with a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia and a principal diagnosis of sepsis or respiratory failure. We performed logistic regression, estimating the likelihood of in-hospital mortality in each year, adjusting for age, sex, and comorbidities.
RESULTS: Over time, there was a substantial increase in the frequency of sepsis and respiratory failure as a principal diagnosis. Length of stay decreased in all 3 principal diagnosis groups. By 2005, the adjusted odds ratio (OR) of death among principal diagnosis pneumonia and respiratory failure hospitalizations decreased to 0.50 (95% confidence interval [CI], 0.49-0.51) and 0.62 (95% CI, 0.58-0.66), respectively, compared with 1993. With all 3 groups combined, there was still a substantial, albeit attenuated, reduction in the risk of mortality (OR(2005) 0.70; 95% CI, 0.69-0.72).
CONCLUSIONS: Survival of patients with community-acquired pneumonia has improved greatly over time. However, interpretation of such findings based on administrative data must be made with caution and careful attention to case definition and coding trends.
Gregory W Ruhnke; Marcelo Coca Perraillon; David M Cutler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-04-11     Revised Date:  2014-03-20    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  266-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Age Factors
Aged, 80 and over
Clinical Coding / statistics & numerical data*,  trends
Community-Acquired Infections / mortality
Hospital Mortality / trends
Length of Stay
Logistic Models
Middle Aged
Pneumonia / mortality*
Respiratory Insufficiency / mortality
Sepsis / mortality
Sex Factors
United States / epidemiology
Young Adult
Grant Support
T32 HS000084/HS/AHRQ HHS
Comment In:
Am J Med. 2013 Nov;126(11):e23   [PMID:  24157296 ]
Am J Med. 2013 Nov;126(11):e25   [PMID:  24157297 ]

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