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 (SCI&D).


METHODS
Retrospective cohort study.


METHODS
Patients with SCI&D admitted with CAP to any Veterans Affairs medical center between September 1998 and October 2000.


METHODS
Hospital administrative data on 260 patients with SCI&D and a CAP diagnosis.


METHODS
Not applicable.


METHODS
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 SCI&D. 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 SCI&D patients with CAP.
Chang
Heidi T
HT
Stritch School of Medicine, Loyola University, Maywood, IL, USA.
Evans
Charlesnika T
CT
Weaver
Frances M
FM
Burns
Stephen P
SP
Parada
Jorge P
JP
D000368:Aged; D017714:Community-Acquired Infections; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014728:Veterans