In Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
OBJECTIVES : Age is important for prognosis in community-onset pneumonia, but how it influences admission decisions in the emergency department (ED) is not well characterized. Using clinical data from the electronic health record in a national cohort, we examined pneumonia hospitalization patterns, variation, and relationships with mortality among older versus younger Veterans.
METHODS : In a retrospective cohort of patients ≥18 years presenting to EDs with a diagnosis of pneumonia at 118 VA Medical Centers 1/1/2006-12/31/2016, we compared observed, predicted, and residual hospitalization risk for Veterans < 70,70-79, ≥ 80 years of age using generalized estimating equations and machine learning models with 71 patient factors. We examined facility variation in residual hospitalization across facilities and explored whether facility differences in hospitalization risk correlated with differences in 30-day mortality.
RESULTS : Among 297,498 encounters, 165,003(55%) were for Veterans <70 years, 61,076(21%) 70-80, and 71,419(24%) >=80. Hospitalization rate was 52%, 67%, and 76%, respectively. After adjusting for other patient factors, age 70-79 had an odds ratio of 1.39(1.34,1.44) and ≥80 had an odds ratio of 2.1(2.0,2.2) compared to age <70. There was substantial variation in hospitalization across facilities among Veterans <70 (<35% hospitalization at the lowest decile of facilities versus >66% at the highest decile) that was similar but with higher risk for patients 70-79 years (54% versus 82%) and ≥80 years (59% versus 85%) and remained after accounting for patient factors, with no consistently positive or negative associations with facility-level 30-day mortality.
CONCLUSIONS : Older Veterans with community-onset pneumonia experience high risk of hospitalization, with widespread facility variation that has no clear relationship to short-term mortality.
IMPACT STATEMENT : Older Veterans with pneumonia have a high risk of hospitalization, with widespread facility-level variation with no clear relationship with mortality. These findings illustrate a need to further examine the benefits and harms of hospitalization for older adults.
Jones Barbara E, Ying Jian, Nevers McKenna, Rutter Elizabeth, Chapman Alec, Brenner Rachel, Samore Matthew H, Greene Tom
2023-Jan-10
Emergency Department, Epidemiology, Hospitalization, Older adult, Pneumonia
