title: Mortality, morbidity, and disease severity of patients with aspiration pneumonia.
abstract: BACKGROUND
  Aspiration pneumonia is a common syndrome, although less well characterized than other pneumonia syndromes. We describe a large population of patients with aspiration pneumonia.
  
  
  METHODS
  In this retrospective population study, we queried the electronic medical records at a tertiary-care, university-affiliated hospital from 1996 to 2006. Patients were initially identified by International Classification of Diseases, 9th Revision code 507.x; subsequent physician chart review excluded patients with aspiration pneumonitis and those without a confirmatory radiograph. Patients with community-acquired aspiration pneumonia were compared to a contemporaneous population of community-acquired pneumonia (CAP) patients. We compared CURB-65 (a clinical prediction rule based on Confusion, Uremia, Respiratory rate, Blood Pressure, and age)-predicted mortality with actual 30-day mortality.
  
  
  RESULTS
  We identified 628 patients with aspiration pneumonia, of which 510 were community-acquired. Median age was 77 years, with 30-day mortality of 21%. Compared to CAP patients, patients with community-acquired aspiration pneumonia had more frequent inpatient admission (99% vs 58%) and intensive care unit admission (38% vs 14%), higher Charlson comorbidity index (3 vs 1), and higher prevalence of do not resuscitate/intubate orders (24% vs 11%). CURB-65 predicted mortality poorly in aspiration pneumonia patients (area under the curve, 0.66).
  
  
  CONCLUSIONS
  Patients with community-acquired aspiration pneumonia are older, have more comorbidities, and demonstrate higher mortality than CAP patients, even after adjustment for age and comorbidities. CURB-65 poorly predicts mortality in this population.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA. michael.lanspa@imail.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lanspa
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Jones
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000401:mortality*; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index