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Chest Infections |

Models of Resolution of Radiographic Abnormalities in Elderly Patients Hospitalized for Community Acquired Pneumonia

Ivanka Djordjevic*, PhD; Tatjana Pejcic, PhD; Desa Nastasijevic-Borovac, MS; Tatjana Radjenovic-Petkovic, MS; Dragana Dacic, MD
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Clinical Center-Nis, Clinic for Lung Diseases, Nis, Serbia


Chest. 2012;142(4_MeetingAbstracts):221A. doi:10.1378/chest.1370307
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Abstract

SESSION TYPE: Respiratory Infections Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To recommend short-term, in hospital chest radiograph follow-up, resolution of chest radiograph abnormalities in relation to clinical cure were studied, predictors for delayed resolution were evaluated and influence of deterioration of radiographic findings during follow-up on prognosis were determined.

METHODS: One hundred twenty patients aged 65 and older, consecutively admitted to a hospital for community acquired pneumonia (CAP) followed up for 28 days in prospective study. Clinical data and scores for clinical improvement at day 7 and clinical cure at day 28 were obtained. Chest radiographs were obtained at hospital admission and at days 7 and 28. Resolution and deterioration of chest radiograph findings were determined.

RESULTS: At day 7, 23 (19.2%) of the patients had resolution of chest radiograph abnormalities, whereas 59 (49.2%) had clinical improvement (p<0.001; odds ratio (OR): 0.60; 95%CI: 0.35-1.00). At day 28, 59 (49.2%) of the patients had resolution of chest radiograph abnormalities and 74 (61.6%) had clinical cure (p<0.069; OR: 0.60; 95%CI: 0.35-1.00). Delayed resolution of radiograph abnormalities was independently associated with multilobar disease (p<0.001; OR: 0.06; 95%CI: 0.02-0.14); altered mental status on admission (p<0.001; OR: 27.1; 95%CI: 7.8-94.2) and high respiratory rate at admision, defined as > 23 breath/min (p<0.001; OR: 5.94; 95%CI: 2.05-17.19). There were no significant difference in outcome at day 28 between patients with and patients without deterioration of chest radiograph findings during the follow-up period (p=0.63).

CONCLUSIONS: The resolution of radiographic abnormalities in the elderly patients with CAP should take into account the extent of lobar disease, mental status and respiratory rate at admission. In the hospitalized elderly patients with CAP routine short-term follow-up chest radiographs (obtained < 28 days after hospital admission) provide no additional clinical value.

CLINICAL IMPLICATIONS: Follow-up chest radiography to exclude noninfectious abnormalities should not be performed within 4 weeks after the initial diagnosis. A delay of at list 8-12 weeks after an episode of community acquired pneumonia is reasonable.

DISCLOSURE: The following authors have nothing to disclose: Ivanka Djordjevic, Tatjana Pejcic, Desa Nastasijevic-Borovac, Tatjana Radjenovic-Petkovic, Dragana Dacic

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Clinical Center-Nis, Clinic for Lung Diseases, Nis, Serbia

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