title: Guideline-recommended management of community-acquired pneumonia in veterans with spinal cord injury.
abstract: BACKGROUND
  Pneumonia is a leading cause of death in persons with spinal cord injuries and disorders (SCI/D), but little is known about guideline-based management for this disease in persons with SCI/D.
  
  
  OBJECTIVE
  The goal of this study was to describe guideline-based medical care for community-acquired pneumonia (CAP) in veterans with SCI/D.
  
  
  METHODS
  A retrospective medical record review was conducted at 7 Department of Veterans Affairs (VA) medical centers where veterans with SCI/D and CAP between 2005 and 2008 were included. Outcomes assessed were receipt of blood or sputum culture, antibiotic timeliness, appropriateness of empiric antibiotic treatment, and vaccination.
  
  
  RESULTS
  In 70 patients, 77 CAP episodes occurred and 83.1% were treated in the inpatient setting. The average age was 70.0 years and 64.9% had tetraplegia. Sputum culture was completed in 24.7% and blood culture in 59.7% of cases. Of inpatients, 79.7% had antibiotic treatment within 8 hours and 45.1% received guideline-recommended empirical antibiotics. More than 90% of inpatients received antibiotic treatment within 3 days of presentation and 78.1% received recommended treatment. The rates of pneumococcal pneumonia (89.9%) and influenza (79.7%) vaccinations were high in CAP cases.
  
  
  CONCLUSIONS
  Diagnostic testing and early guideline-recommended treatment is variable in veterans with SCI/D and CAP. However vaccination against influenza and pneumococcal pneumonia is high. Specific guidelines for management of CAP in SCI/D patients may be needed, which reflect the unique risk factors and needs of this population. These data can be used as a benchmark for improvements in care processes for treating and managing CAP in persons with SCI/D.
authors: Department of Veterans Affairs (VA), Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, Illinois ; Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) , Hines, Illinois ; Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Charlesnika T
authors: CT
authors: Evans
authors: Frances M
authors: FM
authors: Weaver
authors: Thea J
authors: TJ
authors: Rogers
authors: Lauren
authors: L
authors: Rapacki
authors: Scott
authors: S
authors: Miskevics
authors: Bridget
authors: B
authors: Hahm
authors: Bridget
authors: B
authors: Smith
authors: Sherri L
authors: SL
authors: Lavela
authors: Barry
authors: B
authors: Goldstein
authors: Stephen P
authors: SP
authors: Burns
keywords: antibiotics; disease management; pneumonia; practice guideline; spinal cord injuries