Guideline-recommended management of community-acquired pneumonia in veterans with spinal cord injury

• Published in: Topics in spinal cord injury rehabilitation Vol. 18; no. 4; pp. 300 - 305
• Main Authors: Evans, Charlesnika T, Weaver, Frances M, Rogers, Thea J, Rapacki, Lauren, Miskevics, Scott, Hahm, Bridget, Smith, Bridget, Lavela, Sherri L, Goldstein, Barry, Burns, Stephen P
• Format: Journal Article
• Language: English
• Published: United States Thomas Land Publishers, Inc 01.01.2012
• Subjects: Original; pneumonia; spinal cord injuries; antibiotics; practice guideline; disease management
• ISSN: 1082-0744; 1945-5763
• DOI: 10.1310/sci1804-300

Pneumonia is a leading cause of death in persons with spinal cord injuries and disorders (SCI/D), but little is known about guideline-based management for this disease in persons with SCI/D. The goal of this study was to describe guideline-based medical care for community-acquired pneumonia (CAP) in veterans with SCI/D. A retrospective medical record review was conducted at 7 Department of Veterans Affairs (VA) medical centers where veterans with SCI/D and CAP between 2005 and 2008 were included. Outcomes assessed were receipt of blood or sputum culture, antibiotic timeliness, appropriateness of empiric antibiotic treatment, and vaccination. In 70 patients, 77 CAP episodes occurred and 83.1% were treated in the inpatient setting. The average age was 70.0 years and 64.9% had tetraplegia. Sputum culture was completed in 24.7% and blood culture in 59.7% of cases. Of inpatients, 79.7% had antibiotic treatment within 8 hours and 45.1% received guideline-recommended empirical antibiotics. More than 90% of inpatients received antibiotic treatment within 3 days of presentation and 78.1% received recommended treatment. The rates of pneumococcal pneumonia (89.9%) and influenza (79.7%) vaccinations were high in CAP cases. Diagnostic testing and early guideline-recommended treatment is variable in veterans with SCI/D and CAP. However vaccination against influenza and pneumococcal pneumonia is high. Specific guidelines for management of CAP in SCI/D patients may be needed, which reflect the unique risk factors and needs of this population. These data can be used as a benchmark for improvements in care processes for treating and managing CAP in persons with SCI/D.