title: Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes.
abstract: BACKGROUND
  Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes.
  
  
  OBJECTIVE
  We analyzed patient-level covariates associated with clinician-defined aspiration pneumonia.
  
  
  METHODS
  We used the Community-Acquired Pneumonia Organization database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with nonaspiration pneumonia.
  
  
  RESULTS
  We studied 5185 patients. Four hundred fifty-one of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with nonaspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs 13%, P = 0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P < 0.001), and took longer to achieve clinical stability (unadjusted 8 vs 4 days, P < 0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (odds ratio: 4.4, 2.9, 2.3, respectively). Unadjusted inpatient mortality was higher (23% vs 9%, P < 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality after adjusting for age, disease severity, and comorbidities.
  
  
  CONCLUSIONS
  Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration. Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, Utah; Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lanspa
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: Timothy
authors.initials: T
authors.lastname: Wiemken
authors.forename: Emily L
authors.initials: EL
authors.lastname: Wilson
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003221:Confusion / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000639:trends; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome