Etiology and outcomes of Veterans with spinal cord injury hospitalized and community acquired-pneumonia

Chang HT, Evans CT, Weaver FM, Burns SP, Parada JP. Etiology and outcomes of Veterans with spinal cord injury hospitalized and community acquired-pneumonia. Paper presented at: Loyola University Chicago Stritch School of Medicine Annual Forum; 2003 Oct 1; Maywood, IL.

Etiology and outcomes of veterans with spinal cord injury and disorders hospitalized with community-acquired pneumonia. Objective To determine whether documentation of a causative organism for community-acquired pneumonia (CAP) is associated with outcomes, including mortality and length of stay (LOS), in hospitalized veterans with spinal cord injuries and disorders (SCIandD). Design Retrospective cohort study. Setting Patients with SCIandD admitted with CAP to any Veterans Affairs medical center between September 1998 and October 2000. Participants Hospital administrative data on 260 patients with SCIandD and a CAP diagnosis. Interventions Not applicable. Main outcomes measures All-cause, 30-day mortality and hospital LOS. Results An organism was documented by International Classification of Diseases, 9th Revision , discharge codes in 24% of cases. Streptococcus pneumoniae and Pseudomonas aeruginosa accounted for 32% and 21%, respectively, of the identified bacterial pathogens. The overall mortality rate was 8.5%. No significant association was found between etiologic diagnosis of CAP and 30-day mortality. Lower mortality was associated with treatment at a designated SCI center (relative risk = .35; confidence interval, .12-.99). Pathogen-based CAP diagnosis was significantly associated with longer LOS (adjusted r 2 = .023, P = .024). Conclusions There was no association between etiologic diagnosis of CAP and 30-day mortality among people with SCIandD. Documentation of CAP etiology was associated with the variance in LOS. Pneumococcal vaccination and antibiotic therapy with antipseudomonal activity may be particularly prudent in these patients given the high frequency of these pathogens among SCIandD patients with CAP