Etiology and outcomes of veterans with spinal cord injury and disorders hospitalized with community-acquired pneumonia

OBJECTIVE: To determine whether documentation of a causative organism for community-acquired pneumonia (CAP) is associated with outcomes, including mortality and length of stay (LOS), in hospitalized veterans with spinal cord injuries and disorders (SCI&D). DESIGN: Retrospective cohort study. SETTING: Patients with SCI&D admitted with CAP to any Veterans Affairs medical center between September 1998 and October 2000. PARTICIPANTS: Hospital administrative data on 260 patients with SCI&D and a CAP diagnosis. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: All-cause, 30-day mortality and hospital LOS. RESULTS: An organism was documented by International Classification of Diseases, 9th Revision , discharge codes in 24% of cases. Streptococcus pneumoniae and Pseudomonas aeruginosa accounted for 32% and 21%, respectively, of the identified bacterial pathogens. The overall mortality rate was 8.5%. No significant association was found between etiologic diagnosis of CAP and 30-day mortality. Lower mortality was associated with treatment at a designated SCI center (relative risk=.35; confidence interval, .12-.99). Pathogen-based CAP diagnosis was significantly associated with longer LOS (adjusted r 2 =.023, P =.024). CONCLUSIONS: There was no association between etiologic diagnosis of CAP and 30-day mortality among people with SCI&D. Documentation of CAP etiology was associated with the variance in LOS. Pneumococcal vaccination and antibiotic therapy with antipseudomonal activity may be particularly prudent in these patients given the high frequency of these pathogens among SCI&D patients with CAP.