Inappropriate diagnosis of community-acquired pneumonia (CAP) in hospitalized adults is common, especially among older adults and those with dementia, according to a study published in JAMA Internal Medicine. Ashwin Gupta, MD, and colleagues conducted a prospective cohort study to characterize inappropriate diagnosis of CAP in hospitalized patients across 48 hospitals. The researchers found that 12.0% of the 17,290 hospitalized patients treated for CAP met criteria for inappropriate diagnosis; of these, 87.6% received full antibiotic courses. Patients inappropriately diagnosed were older (adjusted OR, 1.08 per decade) and were more likely to have dementia or altered mental status at presentation (adjusted ORs, 1.79 and 1.75, respectively) compared with patients with CAP. Compared with a brief duration of antibiotic treatment (no more than 3 days), full antibiotic treatment was associated with antibiotic-associated adverse events (2.1% vs 0.4%). “Balancing harms of underdiagnosis and overdiagnosis of CAP remains essential,” Dr. Gupta and colleagues wrote.