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Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia

Hirota, Yoshito 京都大学 DOI:10.14989/doctor.k24844

2023.07.24

概要

The number of deaths from aspiration pneumonia in Japan nearly doubled from 2010 to 2020,
with 22,066 deaths in 2010 to 42,746 deaths in 2020 [1], and is expected to triple in the decade
to 2030 as Japanese society ages [2]. Aspiration pneumonia is a pulmonary inflammation
caused by the inhalation of oropharyngeal secretions containing colonized pathogenic bacteria
[3]. A diagnosis is made when a patient with known or strongly suspected dysphagia and aspiration shows radiographic evidence of pneumonia [4]. Aspiration pneumonia has unique epidemiological features and outcomes that differ from community-acquired pneumonia [5].
Compared to those with community-acquired pneumonia, patients with aspiration pneumonia tend to be older and have lower functional status, more comorbidities, longer stays in hospital, and higher mortality [5].
While the discharge destinations for patients with aspiration pneumonia vary from country
to country, patients in Japan are mainly discharged to their home, a nursing home, or a hospital with long-term care beds. Approximately half of all elderly patients with aspiration pneumonia are discharged to nursing homes [6], while one-third are discharged to a place other
than where they lived before admission [7]. Discharging patients to the latter requires further
planning and coordination [8,9]. Discharge planning enhances the safe and timely transfer of
inpatients between different places, thus reducing hospital lengths of stay, resource use, and
readmissions [10–12]. Accurately predicting the discharge destinations of inpatients with aspiration pneumonia is thus a vital issue in discharge planning. Although home discharge prediction models have been developed for surgical patients and stroke patients [13,14], similar
attempts have not been reported for patients with aspiration pneumonia.
Several prior studies have identified key factors related to the home discharge of elderly
patients with pneumonia, including aspiration pneumonia [6,15,16]. These studies showed
that impaired physical function at discharge, low albumin level at admission, artificial nutrition, and respiratory care such as oxygen administration and sputum suctioning at discharge
were negatively associated with home discharge. The generalizability of these results, however,
is limited since most [6,15] were conducted using a single center and a small sample size.
Moreover, some of the factors used in these studies were measured at discharge [6,16], and
thus the results could not be used to predict home discharge based solely on patient characteristics at admission. Therefore, the objective of the current study was to develop and validate
prediction models for the discharge destination of elderly patients with aspiration pneumonia
using baseline patient characteristics that could be determined at the earliest stages of
admission. ...

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