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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The goal of this study was to determine the accuracy and the impact of 5 different claims-based pneumonia definitions. Three International Classification of Diseases, Version 9, (ICD-9), and 2 diagnosis-related group (DRG)-based case identification algorithms were compared against an independent, clinical pneumonia reference standard. Among 10748 patients, 272 (2.5%) had pneumonia verified by the reference standard. The sensitivity of claims-based algorithms ranged from 47.8% to 66.2%. The positive predictive values ranged from 72.6% to 80.8%. Patient-related variables were not significantly different from the reference standard among the 3 ICD-9-based algorithms. DRG-based algorithms had significantly lower hospital admission rates (57% and 65% vs 73.2%), lower 30-day mortality (5.0% and 5.8% vs 10.7%), shorter length of stay (3.9 and 4.1 days vs 5.6 days), and lower costs (USD $4543 and USD $5159 vs USD $8585). Claims-based identification algorithms for defining pneumonia in administrative databases are imprecise. ICD-9-based algorithms did not influence patient variables in our population. Identifying pneumonia patients with DRG codes is significantly less precise.
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PMID:Accuracy of administrative data for identifying patients with pneumonia. 1628 Mar 95

This article examines the impact of the introduction of ICD-10 on respiratory disease mortality statistics in England and Wales, specifically focussing on pneumonia, chronic lower respiratory diseases, and influenza. The main changes are highlighted and the article explains how figures can be adjusted to take account of these changes so that trends over time can be analysed. The number of deaths assigned to the respiratory disease chapter of the ICD as a whole decreased by 22 per cent as a result of the introduction of ICD-10. Although it is not usually recommended that comparability ratios from the CD-10 bridge-coding study are used to adjust rates prior to 1993, our analysis shows that unadjusted data for 1984 to 1992 can be used to examine longer time trends for respiratory diseases as a whole.
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PMID:The impact of introducing ICD-10 on analysis of respiratory mortality trends in England and Wales. 1652 76

This epidemiological survey was undertaken to estimate the burden of hospital admissions for pneumonia and influenza in 50-64 years old persons in Spain during a four-year period (1999-2002). Data were obtained from the national surveillance system for hospital data maintained by the Ministry of Health and covering more than 95% of Spanish hospitals. There were 35,620 hospital admissions for pneumonia and influenza (ICD 9 CM 480-487; first listed diagnosis) during the study period. Annual incidence was 143 cases per 100,000 population. Rate of death and case-fatality rate were 8 per 100,000 population and 5.6%, respectively. The average length of hospitalization was 10.4 days. Men and older age groups showed a higher incidence, rate of death and case-fatality rate. These hospitalizations of 50-64 years old persons impose an annual direct cost of 12 to 24 millions euros. Preventive measures, such as vaccination will reduce pneumonia-related morbidity and could result in large cost savings to the Health Care System.
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PMID:Hospitalization by pneumonia and influenza in the 50-64 year old population in Spain (1999-2002). 1701 81

This study examines the validity of using ICD-10 codes to identify hospitalized pneumonia cases. Using a case-cohort design, subjects were randomly selected from monthly cohorts of patients aged > or = 65 years discharged from April 2000 to March 2002 from two large tertiary Australian hospitals. Cases had ICD-10-AM codes J10-J18 (pneumonia); the cohort sample was randomly selected from all discharges, frequency matched to cases by month. Codes were validated against three comparators: medical record notation of pneumonia, chest radiograph (CXR) report and both. Notation of pneumonia was determined for 5098/5101 eligible patients, and CXR reports reviewed for 3349/3464 (97%) patients with a CXR. Coding performed best against notation of pneumonia: kappa 0.95, sensitivity 97.8% (95% CI 97.1-98.3), specificity 96.9% (95% CI 96.2-97.5), positive predictive value (PPV) 96.2% (95% CI 95.4-97.0) and negative predictive value (NPV) 98.2% (95% CI 97.6-98.6). When medical record notation of pneumonia is used as the standard, ICD-10 codes are a valid method for retrospective ascertainment of hospitalized pneumonia cases and appear superior to use of complexes of symptoms and signs, or radiology reports.
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PMID:ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged > or = 65 years. 1744 19

Benefits from influenza and 23-valent pneumococcal polysaccharide (23vPPV) vaccines against invasive pneumococcal disease and laboratory confirmed influenza have been well documented. However, their effectiveness against pneumonia remains controversial for community-based elderly > or = 65 years. Using a case-cohort design we examined incremental VE of 23vPPV over and above influenza vaccine against hospitalization with community-acquired pneumonia (HCAP) in two large Australian hospitals. 1952 cases (ICD-10-AM codes for pneumonia: J10-J18) and 2927 randomly selected cohort subjects were studied. Vaccination status was confirmed by providers. Benefit against HCAP was not demonstrated in multivariate analysis for influenza vaccine compared with neither vaccine (RR 1.02, 95%CI 0.84-1.20) or for both vaccines compared with influenza vaccine (RR 0.98, 95%CI 0.81-1.18). The current program of funding these vaccines for the elderly is not having a discernable impact on HCAP in this setting.
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PMID:Prevention of community-acquired pneumonia among a cohort of hospitalized elderly: benefit due to influenza and pneumococcal vaccination not demonstrated. 1747 15

In a population-based study, we use ICD-9-CM codes to estimate the hospitalization rates for pneumococcal disease among young children in Hong Kong, 2000-2005 and the preventable burden using several outcome indicators. For children aged </=2 years, the average admission rates (per 100,000 person-years) were 23.7 for invasive pneumococcal disease (IPD), 1047.5 for clinical pneumonia and 213 for radiological pneumonia. For this group of children, the disease burden potentially preventable by vaccination, per 100,000 person-years, were estimated to be 19.3 (95% CI, 16.7-21.9) for IPD, 58.5 (95% CI, 57.3-59.6) for clinical pneumonia and 40.6 (95% CI, 59-82.2) for radiological pneumonia.
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PMID:Pediatric hospitalization for pneumococcal diseases preventable by 7-valent pneumococcal conjugate vaccine in Hong Kong. 1771 37

Diagnosed obstructive sleep apnea affects 2-4% of middle aged Americans and represents a substantial health care burden. Despite its prevalence, little is known about the demographic characteristics or clinical management of sleep apnea patients hospitalized for other comorbidities and surgeries. The aim of this study was to provide a broad characterization of the epidemiology of sleep apnea in hospitalized patients in the United States and to describe the trends in the management of their sleep apnea during their hospitalizations. Using the 2004 National Hospital Discharge Survey (NHDS), a nationally representative sample of discharges from nonfederal acute care hospitals in the United States, cases of sleep apnea were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The specific objectives of this study were to: (1) describe the prevalence of hospitalized unspecified sleep apnea individuals according to age, gender, and comorbidities; (2) estimate prevalence of the use of continuous positive airway pressure (CPAP) therapy during hospitalization and describe those uses according to hospital ownership and size. A retrospective analysis of data of hospitalized patients with unspecified sleep apnea from the 2004 National Hospital Discharge Survey (NHDS) was completed. In 2004, the NHDS collected data for approximately 371,000 discharges from a sample of 439 nonfederal short-stay hospitals. An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. Patients diagnosed with unspecified sleep apnea were identified using the International Classification of Diseases (Ninth Revision), Clinical Modification (ICD-9-CM) code of 780.57, which, before 2005, was the sole diagnostic code under which obstructive sleep apnea was listed. A subset of these patients, those receiving CPAP therapy, was further identified using the ICD-9-CM procedural code 93.90. Review of weighted discharge data identified a total of 293,478 estimated cases of unspecified sleep apnea. Approximately 64% of these individuals were between the ages 40 and 69 years old with a gender distribution of 55.3% males. The most common diagnoses in hospitalized sleep apnea patients were morbid obesity, congestive heart failure, coronary artery disease, exacerbation of COPD, and pneumonia. Sleep apnea was managed through the standardized therapy, CPAP, in 5.8% of hospitalized patients and CPAP therapy was more likely to be utilized in sleep apnea patients hospitalized in a government hospital than in a for-profit hospital. In conclusion, only a small percentage (5.8%) of patients diagnosed with unspecified sleep apnea in the 2004 NHDS were provided with CPAP therapy during hospitalization. There appear to be institutional differences in the utilization of CPAP therapy in hospitals across the United States. These findings suggest that in the United States, the management of sleep apnea in hospitalized patients is deficient, and the use of CPAP therapy in the hospital warrants further investigation.
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PMID:Prevalence of unspecified sleep apnea and the use of continuous positive airway pressure in hospitalized patients, 2004 National Hospital Discharge Survey. 1823 92

This study describes the epidemiology of community-acquired pneumonia (CAP) in elderly Australians for the first time. Using a case-cohort design, cases with CAP were in-patients aged > or = 65 years with ICD-10-AM codes J10-J18 admitted over 2 years to two tertiary hospitals. The cohort sample was randomly selected from all hospital discharges, frequency-matched to cases by month. Logistic regression was used to estimate risk ratios for factors predicting CAP or associated mortality. A total of 4772 in-patients were studied. There were 1952 cases with CAP that represented 4% of all elderly admissions: mean length of stay was 9.0 days and 30-day mortality was 18%. Excluding chest radiograph, 520/1864 (28%) cases had no investigations performed. The strongest predictors of CAP were previous pneumonia, history of other respiratory disease, and aspiration. Intensive-care-unit admission, renal disease and increasing age were the strongest predictors of mortality, while influenza vaccination conferred protection. Hospitalization with CAP in the elderly is common, frequently fatal and a considerable burden to the Australian community. Investigation is ad hoc and management empirical. Influenza vaccination is associated with reduced mortality. Patient characteristics can predict risk of CAP and subsequent mortality.
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PMID:Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study. 1855 26

The present study was conducted to determine the incidence and risk factors for nosocomial pneumonia (NP) among intubated patients in a provincial hospital, eastern Thailand. Three hundred five intubated patients who voluntarily participated and signed informed consent were observed and medical records were collected. The respiratory secretion specimens from NP patients, diagnosed by doctors under the definition of the International Statistical Classification of Disease and Related Health Problems Tenth Revision (ICD-10), were collected for bacterial culture. Data from patients with and without NP were analyzed to identify risk factors. The results revealed that the incidence of NP was 38.4% (117/305 cases). Of 117 NP patients, 35% were positive on bacterial culture. The most frequently isolated bacteria were Klebsiella pneumoniae and Klebsiella spp (32%), and the incidence of methicillin resistant Stapylococcus aureus (MRSA) was 6%. Risk factors for NP from univariate analysis were (a) age more than 60 years (OR = 9.2, p < 0.001), (b) admitted to the ICU (OR = 1.7, p=0.042), (c) comatose (OR = 12.2, p < 0.001), (d) chronic pulmonary disease (OR = 5.3, p < 0.001), tuberculosis (OR = 14.3, p < 0.001), (e) smoking (OR = 7.1, p < 0.001), and (f) duration of intubation greater than 5 days (OR = 8.8, p < 0.001). After controlling for confounders using multivariate analysis, the significant risk factors were (a) age greater than 60 years (OR = 9.9, p < 0.001), (b) comatose (OR = 9.4, p = 0.031), (c) chronic pulmonary disease (OR = 5.2, p < 0.001), tuberculosis (OR=I 1.4, p = 0.003), (d) smoking (OR = 3.6, p < 0.001), and (e) duration of intubation more than 5 days (OR = 18.9, p < 0.001). When an intubated patient has these risk factors, they should be considered a potential risk for NP and preventive measures should be taken to reduce the risk.
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PMID:Incidence and risk factors for nosocomial pneumonia among intubated patients in a provincial hospital, Eastern Thailand. 1856 58

An 82-year-old male Bangkokian with hypertension, diabetes mellitus, end-stage renal disease, and coronary artery disease for many years, was hospitalized due to deterioration of a 3-day influenza-like-illness with one-day chest oppression and respiratory failure. At the emergency room, oxygen saturation was 79% on room air Chest X-ray revealed bilateral diffuse pulmonary infiltrates. He was intubated and hemodialysis was initiated. Emergency coronary angiography revealed patent coronary artery. Sputum gram stain revealed numerous leukocytes with no bacteria. On day three of hospitalization, empiric treatment with oseltamivir and clarithromycin was administered Seventy-two hours later his clinical condition began to improve and fever subsided 7 days later Rapid test of tracheal secretion with immunofluorescence assay was positive for moderate amount of influenza A virus. Viral isolation yielded influenza A virus subtype H1N1. Review of in-patient records at this hospital using ICD-10 codes as J10 and J11 during 1995-2005, discovered 32 cases with claim diagnosis of influenza. However this is the first case with proven influenza pneumonia that was given empiric oseltamivir. Rapid deterioration of influenza-like illness due to human influenza virus in the elderly and pathogenesis of pulmonary in this case are discussed to alert physicians to recognize this dreadful illness and treat it in timely fashion.
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PMID:Fulminating influenza pneumonia in the elderly: a case demonstration. 1869 95


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