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Pneumonia Misdiagnosis on Readmission Frequent, Costly

By Roxanna Guilford-Blake, for HealthLeaders Media  
   October 28, 2010

Pneumonia is frequently misdiagnosed upon readmission, leading to overuse of antibiotics and higher healthcare costs, according to two companion studies.

Patients were misdiagnosed with pneumonia at dramatically high rates when they were readmitted to the hospital shortly after a previous hospitalization for the illness, according to the research presented at the Infectious Diseases Society of America annual meeting in Vancouver, BC.

Researchers examined the medical records of 127 patients who were diagnosed with pneumonia and readmitted within 30 days of a hospital discharge. Of this group, they found that 92 were misdiagnosed with healthcare-associated pneumonia (a newly recognized form of pneumonia in patients who have had recent close contact with a healthcare system.)

Blacks were more than twice as likely as whites to be misdiagnosed with pneumonia, and smokers and those with lung disease were also more likely to be misdiagnosed.

The misdiagnoses are bad for patients and hospitals. They lead to inappropriate use of a broad spectrum of antibiotics as therapy for healthcare-associated pneumonia, and in the future may not be paid for by CMS under the Hospital-Acquired Conditions initiative, according to researchers.

A call for vigilance

Researchers pointed out several possible reasons for the misdiagnosis, including pre-existing lung disease and baseline chest radiographic abnormalities.

These studies indicate a need to increase awareness among physicians about using the diagnostic standards and criteria set forth in the Centers for Disease Control and Prevention's National Healthcare Safety Network for diagnosing pneumonia at the time of readmission, says Hiren Pokharna, MD, a fellow at Henry Ford Hospital and the lead author of the studies.

Physicians need to be open to other diagnoses—especially once the patient is admitted, he says. Those who indeed had pneumonia were more likely to have a fever and altered mental status, he pointed out.

The patient is often diagnosed with pneumonia and started on antibiotics in the emergency department. (The research found that 76 percent of the diagnoses—accurate and otherwise—were made there.) Failure to overrule this diagnosis after readmission is the problem, he explains, noting the patient may be diagnosed with pneumonia in the emergency department, but that doesn't mean it should remain the final diagnosis—especially because COPD and chronic bronchitis, among other conditions, can mimic pneumonia.

"Pneumonia is a diagnosis of ease." It's up to the doctor who sees the patient on the floor to change the diagnosis if appropriate, Pokharna says. "Be vigilant over the next few days." Consider other diagnoses. "Keep an open mind."

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