Discordant Pneumonia Diagnosis From Presentation to Discharge Common

MONDAY, Aug. 5, 2024 (HealthDay News) -- Discordant diagnoses from initial presentation to discharge occur in more than half of patients hospitalized and treated for pneumonia, according to a study published online Aug. 6 in the Annals of Internal Medicine.

Barbara E. Jones, M.D., from the University of Utah and Salt Lake City VA Healthcare System, and colleagues examined the evolution of pneumonia diagnoses among patients hospitalized from the emergency department in a retrospective nationwide cohort study conducted at 118 U.S. Veterans Affairs medical centers.

The researchers found that 13.3 percent of the 2,383,899 hospitalizations received an initial or discharge diagnosis and treatment of pneumonia; 9.1 and 10.0 percent received an initial and a discharge diagnosis, respectively. In 57 percent of patients, there were discordances seen between initial and discharge diagnoses. Thirty-three percent of those discharged with pneumonia diagnosis and positive initial chest image lacked an initial diagnosis. Thirty-six percent of those discharged initially lacked a discharge diagnosis and 21 percent did not have positive initial chest imaging. Uncertainty was often expressed in clinical notes: 58 and 48 percent in emergency department and at discharge, respectively. Greater uncertainty was seen for patients with discordant diagnoses, and they received more additional treatments; compared with concordant patients, only those lacking an initial pneumonia diagnosis had higher 30-day mortality (14.4 versus 10.6 percent).

"Our study suggests that diagnostic discordance, uncertainty, and treatment ambiguity are common features of clinical care for patients hospitalized with pneumonia, with important bearings on patient care and outcomes," the authors write.

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