Introduction and objectives Aspiration-related pneumonia accounts for 10–15% of cases hospitalised with community acquired pneumonia. Guideline-directed pathways for the diagnosis and management of AP are lacking in detail (BTS/ATS/IDSA). The local practice of assessing patients admitted with primary diagnosis of AP and outcome was evaluated in a large tertiary hospital in the UK.
Methods A retrospective cohort study that reviewed the case notes of 34 consecutive patients admitted to hospital with a high likelihood for a diagnosis of community acquired aspiration pneumonia (CAAP). Aspiration risk assessment on admission, appropriate antimicrobial therapy, dietetic and Speech and Language Therapy (SALT) team input, airway assessment, length of hospital stay and mortality were included in the data analysis.
Results A crude risk assessment for aspiration was performed in all patients on admission. An aspiration event was witnessed in 35% of cases. Pre-existing neurological pathology was the predominant risk factor (70%). Appropriate antimicrobial therapy was commenced within 4 h of admission in 14 (58%) cases. Airway assessment by a SALT team was performed in 4 patients within 48 h of admission. None of the patients underwent video fluoroscopy. An initial dietetic review within 72 h of admission was observed in 6 patients (18%). Median hospital stay was 8 days and in hospital mortality was 41%.
Conclusion The study demonstrates a significant inconsistency in the initial management of patients hospitalised with AP. The lack of early intervention by SALT and dietetic services and routine video fluoroscopy use in the majority of patients is of concern. A specific guideline with an evidence based diagnostic pathwayand managementis needed for patients at high risk for AP.
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