Chest
Original Research: Chest InfectionsPleural Effusions at First ED Encounter Predict Worse Clinical Outcomes in Patients With Pneumonia
Section snippets
Study Population
ED patients with pneumonia seen in seven Intermountain Healthcare Hospitals in the urban corridor of Utah were studied. Patient enrollment occurred during two 12-month periods: December 2009 through November 2010, and December 2011 through November 2012. Most patients in the present study were originally enrolled in a study of the implementation of a pneumonia electronic clinical decision support tool; the gap year between December 2010 and November 2011 was the period of tool deployment.12
All
Results
Of the 458,837 adult patients who were admitted to the study EDs, 4,771 had pneumonia and fulfilled the entry criteria. Among these subjects, 690 (14.5%) had a pleural effusion (Fig 1). The effusions were small in 563 (81.6% of all the patients with effusions), moderate in 101 (14.6%), and large in 26 (3.8%) patients. Pleural effusions were defined by using chest CT scans in 263 (38.1%), 280 (40.6%) by upright CXR imaging, and 147 (21.3%) by supine portable CXR imaging in the EDs. Pleural
Discussion
In this study, patients with pneumonia with radiologically defined pleural effusions at ED presentation were more likely to die by 30 days, more likely to be admitted to the hospital, and had a longer length of stay compared with patients without effusion, even after adjustment for severity of illness. Importantly, eCURB/CURB-65 significantly underestimated the 30-day mortality of patients with pneumonia presenting with a pleural effusion. These data suggest that the presence of a pleural
Conclusions
Patients with pneumonia presenting with a pleural effusion had more comorbid illnesses, experienced higher rates of mortality and hospital admissions, and had longer stays in the hospital. Clinicians must recognize the implication on clinical outcome conferred by the presence of an effusion. Targeted therapies or increased attention to fluid drainage might be needed to improve outcome in this patient population.
Acknowledgments
Author contributions: N. C. D. conceived the original idea for this study, performed critical revision of the manuscript for intellectual content, obtained funding, and is overall responsible for the content of the manuscript, including the data and analysis. P. P. G. performed data acquisition, analysis, and interpretation of data, and drafted the initial manuscript. J. S. S. was primarily responsible for statistical analysis and performed critical revision of the manuscript for intellectual
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FUNDING/SUPPORT: This work was funded in part by the Intermountain Research and Medical Foundation. Dr Jones was supported by a training grant [5 T32–HL-105321-1] from the National Institutes of Health.