• Michael J Lanspa, Paula Peyrani, Timothy Wiemken, Emily L Wilson, Julio A Ramirez, and Nathan C Dean.
• Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, Utah; Division of Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
• J Hosp Med. 2015 Feb 1; 10 (2): 90-6.

BackgroundAspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes.ObjectiveWe analyzed patient-level covariates associated with clinician-defined aspiration pneumonia.MethodsWe used the Community-Acquired Pneumonia Organization database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with nonaspiration pneumonia.ResultsWe studied 5185 patients. Four hundred fifty-one of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with nonaspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs 13%, P = 0.002), had longer unadjusted hospital length of stay (9 vs 7 days, P < 0.001), and took longer to achieve clinical stability (unadjusted 8 vs 4 days, P < 0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (odds ratio: 4.4, 2.9, 2.3, respectively). Unadjusted inpatient mortality was higher (23% vs 9%, P < 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality after adjusting for age, disease severity, and comorbidities.ConclusionsAmong pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration. Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.© 2014 Society of Hospital Medicine.

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