Age- and sex-related differences in community-acquired pneumonia at presentation to the emergency department: a retrospective cohort study.

Abstract

Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential. To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP. Retrospective cohort study. Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018. Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence. In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07-0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05-0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08-0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03-0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04-0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07-0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, -14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, -0.18 to -0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81-12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67-2.23). Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.