Clinical research study
Diagnosis of Pulmonary Malignancy after Hospitalization for Pneumonia

https://doi.org/10.1016/j.amjmed.2009.08.009Get rights and content

Abstract

Background

Many physicians recommend that patients receive follow-up chest imaging after the diagnosis of pneumonia to ensure that a pulmonary malignancy is not missed. However, there is little research evidence to support this practice. Our aims were to assess the frequency of the diagnosis of pulmonary malignancy, and to identify risk factors for pulmonary malignancy following hospitalization for pneumonia.

Methods

By excluding patients with a prior diagnosis of pulmonary malignancy, we examined the incidence of a new pulmonary malignancy diagnosis in inpatients aged ≥65 years with a discharge diagnosis of pneumonia in fiscal years 2002-2007, and at least 1 year of Department of Veterans Affairs outpatient care before the index admission.

Results

Of 40,744 patients hospitalized with pneumonia, 3760 (9.2%) patients were diagnosed with pulmonary malignancy after their index pneumonia admission. Median time to diagnosis was 297 days, with only 27% diagnosed within 90 days of admission. Factors significantly associated with a new diagnosis of pulmonary malignancy included history of chronic pulmonary disease, any prior malignancy, white race, being married, and tobacco use. Increasing age, Hispanic ethnicity, need for intensive care unit admission, and a history of congestive heart failure, stroke, dementia, or diabetes with complications were associated with a lower incidence of pulmonary malignancy.

Conclusion

A small, but clinically important, proportion of patients are diagnosed with pulmonary malignancy posthospitalization for pneumonia. Additional research is needed to examine whether previously undiagnosed pulmonary malignancies might be detected at admission, or soon after, for those hospitalized with pneumonia.

Section snippets

Methods

For this study we used data from the administrative databases of the Department of Veterans Affairs (VA) Health Care System. These databases are the repositories of clinical data from all of the VA hospitals and outpatient clinics.5 The Institutional Review Board of the University of Texas Health Science Center at San Antonio approved this study under expedited review.

Results

We identified 40,744 patients who met the inclusion criteria and who did not have a diagnosis of pulmonary malignancy before the pneumonia hospitalization. The mean age was 77.7 years, SD 6.8 years; 53.0% of subjects were married and 98.1% were male. In this cohort, 10.5% were black, 66.6% were white, 1.5% were Hispanic, 4.6% were other, and 16.8% were of unknown race/ethnicity. Regarding mortality, 12.9% (n = 5270) of the subjects died within 30 days of admission, and 20.7% (n = 8451) died within

Discussion

We found that a small, but clinically important, number of elderly patients with pneumonia are diagnosed with posthospitalization pulmonary malignancy. Our results support the concept of follow-up imaging for elderly patients with pneumonia. However, as this is a retrospective study, we are unable to comment on the appropriate time frame or imaging modality (eg, chest radiograph, computed tomography of the chest).

In our study we found that there were significant differences in several comorbid

References (18)

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Funding: The project described was supported by Grant Number R01NR010828 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. Dr Copeland is funded by Merit Review Entry Program grant MRP-05-145 from the VA Health Services Research and Development program. Dr. Restrepo is funded by a KL2 of the National Institutes of Health and the University of Texas Health Science Center at San Antonio. The funding agencies had no role in conducting the study, or role in the preparation, review, or approval of the manuscript.

Conflict of Interest: None of the authors have any conflicts of interests to disclose regarding this article.

Authorship: All authors had free access to the data and were actively involved in writing the manuscript.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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