P244 Accuracy of Admission Diagnosis of Pneumonia. (14th November 2013)

• Record Type: Journal Article
• Authors: Price, Lc; Anwar, Ms; Srikanthan, K; Bercusson, A; Williams, E; Prior, E; Owusu-Ageyi, A; Umpleby, H; Berry, M
• Is Part Of: Thorax. Volume 68(2013)Supplement 3
• Page Start: A187
• Page End: A187
• Publication Date: 2013-11-14
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2013-204457.396
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: The inclusion of 'new infiltrates' on the admission chest radiograph (CXR) is part of the BTS audit tool (1), but it has been reported that up to 37% of inpatients coded (using the ICD-10 coding system) as pneumonia did not have CXR consolidation (2). We assessed our local audit population for potential reasons for this pneumonia miscoding. Methods: Patients selected by coding for the 2012/13 BTS Pneumonia Audit at hospitals within Imperial Healthcare Trust (Charing Cross (CX), Hammersmith (HH) and St Mary's (SMH) Hospitals) underwent a notes review. Results: Of all patients clinically coded as community-acquired pneumonia (CAP), 88/176 (50%) had a diagnosis of CAP compatible with the audit criteria, with infiltrates on the admission CXR–in 15 (39%), 25 (61%) and 48 (50%) of cases at CX, HH and SMH respectively. Of the patients found not to have CAP by the current BTS audit criteria (n = 88), 47/88 (53%) had an abnormal admission CXR not showing CAP. The main abnormalities in these admission CXRs were pulmonary oedema (in 30%), COPD/bronchiectasis (27%), malignancy (13%), interstitial lung disease (ILD) (7%) and pleural effusions (7%). In the 88 'non-audit criteria CAP' patients, in combination with symptoms, inflammatory markers (WCC 10.4 (1.7–33) x10 9 and CRP 84.8 (3.6–381) mg/L), and the CXR series, the likely diagnosis was felt to be LRTI (35%), CAP (17%), HAP (13%), COPD (10%), pulmonary oedema (9%), malignancy (4.5%), UTI (3%), and ILD, asthma and effusions (all 2%), in the 'non-audited CAP' patients. Of those remaining 41 patients with a normal admission CXR excluded from the audit, 24 patients (59%) had a repeat CXR within 72h, of which 5 (21%) then showed CAP. An additional 12 patients with normal admission CXRs had CT scans performed within 72h, 6 of which (50%) detected consolidation. Thus, of all the patients with a normal admission CXR, 11 (27%) had CAP that was missed by solely looking at the admission CXR. Conclusion: We confirm earlier findings that coding diagnoses are insufficiently accurate to judge quality of care, but also show that current audit criteria exclude a significant proportion of cases. References: WS Lim, et al. Thorax 2011;66:548–549 Ruickbie SV, et al. Thorax 2012;67(Suppl 2):A69