Association between delayed diagnosis and treatment and pneumonia mortality in elderly patients, Buriram Hospital, Thailand

Abstract

Pneumonia is an infectious disease of lung parenchyma. In Thailand, the mortality rate of pneumonia is mainly found in elderly group. Delayed diagnosis and treatment is hypothesized to be a possible factor of pneumonia mortality rate in elderly patients because pneumonia clinical presentation in the elderly is hardly detected. The age-matched case-control study was carried out among elderly patients. The medical records of patients age 60 years or older with community-acquired pneumonia (CAP) from 1st January 2016 to 31st December 2018 were retrieved. Case group was 110 deaths caused by pneumonia and control group was 110 patients who recovered from pneumonia. Factors provided p-value less than or equal 0.2 were further analyzed by multivariable conditional logistic regression. All 220 elderly CAP patients without HIV infection were reported, case group mainly had symptoms as dyspnea (72.7%), fever (55.5%), and cough (49.1%), whereas the control group showed fever (74.5%), cough (69.1%), and dyspnea (20.9%). All of the cases had respiratory failure. Septic shock was 60.0% in case group and 15.5% in control group. Delayed diagnosis and treatment (ORadj 5.87 (95%CI: 2.53 - 13.62)), alcohol drinking behavior (ORadj 9.40 (95%CI: 2.73 - 32.34)) were found to have significant association with pneumonia as the leading cause of death among elderly patients. The problem of alcohol consumption and delayed diagnosis and treatment in elderly patients are presented in order to raise the concerned among physicians and health care workers to improve pneumonia case management.