title: Etiology and outcomes of veterans with spinal cord injury and disorders hospitalized with community-acquired pneumonia.
abstract: 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.
authors.affiliation: Stritch School of Medicine, Loyola University, Maywood, IL, USA.
authors.forename: Heidi T
authors.initials: HT
authors.lastname: Chang
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.forename: Jorge P
authors.initials: JP
authors.lastname: Parada
mesh_terms: 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