Pleural Effusions in Patients Diagnosed with Pneumonia in Urgent Care Clinics

Authors

Nathan C. Dean (orcid 0000-0002-1996-0533), Intermountain Health and the University of Utah School of MedicineFollow
Jacqueline R. Eve, Enterprise Analytics, Intermountain HealthFollow
Allison M. Butler, Enterprise Analytics, Intermountain HealthFollow
James H. Hart, Intermountain HealthFollow
Theadora Sakata, Healthcare Delivery Institute, Intermountain HealthFollow
Karen E. Connor, Imaging Services, Intermountain HealthFollow
Edward A. Stenehjem, University of Colorado School of MedicineFollow
Y.C.G. Lee, University of Western AustraliaFollow

#1051464

Funder

Agency for Healthcare Research and Quality (grant #5R18HS02688)

Abstract

Introduction: Pleural effusions in patients with community-acquired pneumonia have been associated with worse outcomes in emergency department and hospital inpatient populations, but the incidence of effusions and their outcomes in outpatient urgent care clinics is unknown. This observational cohort study describes patients diagnosed with pneumonia and pleural effusions on upright 2-view chest X-rays performed in urgent care clinics.

Methods: We extracted electronic health record data from January 2019 through December 2020 on all patients over 12 years old with an International Statistical Classification of Diseases 10^th revision diagnosis of pneumonia entered by the treating clinician, plus “possible” or “likely” radiographic pneumonia identified in the clinical radiologist report. We excluded patients without recorded vital signs and those with a prior episode of pneumonia in the prior 30 days.

Results: Of 5211 patients with documented vital signs, 93 (1.8%) had clinically significant effusions: 64 unilateral and 29 bilateral. Multiple logistic regression showed that older age and higher Charlson comorbidity index scores were associated with pleural effusions (AUC 0.78).

Patients with effusions had higher Pneumonia Severity Index scores, lower SpO2, and higher Shock Index scores than patients without effusions. A greater percentage of pneumonia patients with clinically significant pleural effusion 33 (35%) were admitted to the ED or hospital within 7 days compared to those who had pneumonia but no effusion 575 (11%, P

Conclusions: Fewer urgent care clinic patients diagnosed with community-acquired pneumonia have pleural effusions compared with emergency department and hospital cohorts, but the association with higher illness severity and downstream medical care remain.

DOI

10.55504/2473-2869.1272

ORCID

0000-0002-1996-0533

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Dean, Nathan C.; Eve, Jacqueline R.; Butler, Allison M.; Hart, James H.; Sakata, Theadora; Connor, Karen E.; Stenehjem, Edward A.; and Lee, Y.C.G. (2024) "Pleural Effusions in Patients Diagnosed with Pneumonia in Urgent Care Clinics," The University of Louisville Journal of Respiratory Infections: Vol. 8 : Iss. 1 , Article 2.
DOI: https://doi.org/10.55504/2473-2869.1272
Available at: https://ir.library.louisville.edu/jri/vol8/iss1/2