Diagnosis of pulmonary malignancy after hospitalization for pneumonia.
BACKGROUND
Many physicians recommend that patients receive follow-up chest imaging after the diagnosis of pneumonia to ensure that a pulmonary malignancy is not missed. However, there is little research evidence to support this practice. Our aims were to assess the frequency of the diagnosis of pulmonary malignancy, and to identify risk factors for pulmonary malignancy following hospitalization for pneumonia.


METHODS
By excluding patients with a prior diagnosis of pulmonary malignancy, we examined the incidence of a new pulmonary malignancy diagnosis in inpatients aged >/=65 years with a discharge diagnosis of pneumonia in fiscal years 2002-2007, and at least 1 year of Department of Veterans Affairs outpatient care before the index admission.


RESULTS
Of 40,744 patients hospitalized with pneumonia, 3760 (9.2%) patients were diagnosed with pulmonary malignancy after their index pneumonia admission. Median time to diagnosis was 297 days, with only 27% diagnosed within 90 days of admission. Factors significantly associated with a new diagnosis of pulmonary malignancy included history of chronic pulmonary disease, any prior malignancy, white race, being married, and tobacco use. Increasing age, Hispanic ethnicity, need for intensive care unit admission, and a history of congestive heart failure, stroke, dementia, or diabetes with complications were associated with a lower incidence of pulmonary malignancy.


CONCLUSIONS
A small, but clinically important, proportion of patients are diagnosed with pulmonary malignancy posthospitalization for pneumonia. Additional research is needed to examine whether previously undiagnosed pulmonary malignancies might be detected at admission, or soon after, for those hospitalized with pneumonia.
Mortensen
Eric M
EM
VERDICT Research Program and South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, USA. mortensene@uthscsa.edu
Copeland
Laurel A
LA
Pugh
Mary Jo
MJ
Fine
Michael J
MJ
Nakashima
Brandy
B
Restrepo
Marcos I
MI
de Molina
Rosa Malo
RM
Anzueto
Antonio
A
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010351:Patient Discharge; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D011336:Probability; D016016:Proportional Hazards Models; D011859:Radiography; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013997:Time Factors