Discordant diagnoses from initial presentation to discharge occur in more than half of patients hospitalized and treated for pneumonia, according to a study published in the Annals of Internal Medicine. In a retrospective cohort study, Barbara E. Jones, MD, and colleagues examined pneumonia diagnoses among hospitalized patients at 118 VA medical centers. The researchers found that 13.3% of the 2,383,899 hospitalizations received either an initial or discharge diagnosis and treatment of pneumonia; 9.1% and 10% received an initial and a discharge diagnosis, respectively. In 57% of patients, researchers found discordances between initial and discharge diagnoses. Some 33% of those discharged with pneumonia diagnosis and positive initial chest image lacked an initial diagnosis. In addition, 36% of those discharged initially lacked a discharge diagnosis, and 21% did not have positive initial chest imaging. The researchers found uncertainty in clinical notes: 58% and 48% in EDs and at discharge, respectively. Patients lacking an initial pneumonia diagnosis had higher 30-day mortality compared with patients who had concordant diagnoses (14.4% vs 10.6%).
