Prediction model for prolonged length of stay in patients with community-acquired pneumonia based on Japanese administrative data |
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| Authors: | Hironori Uematsu Kazuto Yamashita Susumu Kunisawa Yuichi Imanaka |
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| Affiliation: | 1. Kyoto Pharmaceutical Association, 563 Bairin-cho, Higashioji Gojo Agaru, Higashiyama-ku, Kyoto, 605-0863, Japan;2. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan;3. Oral Rehabilitation, Niigata University Medical and Dental Hospital, 754 Asahimachi-dori Ichibancho, Chuo-ku, Niigata, 951-8520, Japan;4. College of Pharmaceutical Sciences, Ritsumeikan University, 1-1-1 Noji-higashi, Kusatsu, Shiga, 525-8577, Japan;5. Department of Respiratory Internal Medicine, St. Marianna University School of Medicine, Yokohama-City Seibu Hospital, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan;6. NPO Association of Inhalation Therapist, 1197-1 Yasashi-cho, Asahi-Ku, Yokohama, Kanagawa, 241-0811, Japan;1. Department of Respiratory Medicine, Yodogawa Christian Hospital, Osaka, Japan;2. Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan;1. Department of Respiratory Medicine, Kyoto University, Graduate School of Medicine, Kyoto, Japan;2. Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan;3. Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan;1. Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan;2. Division of Pulmonary Medicine, Department of Thoracic Surgery, Jichi Medical University, Tochigi, Japan;1. Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan;2. Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo 060-0812, Japan |
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| Abstract: | BackgroundThe length of hospital stay in community-acquired pneumonia patients is closely associated with medical costs, the burden of which is increasing in aging societies. Herein, we developed and validated models for predicting prolonged length of stay in community-acquired pneumonia patients to support efficient care in these patients.MethodsWe obtained data of 32,916 patients hospitalized for pneumonia who were discharged between 2012 and 2013 from 304 acute care hospitals in Japan. Logistic regression models were developed with prolonged length of stay as the outcome and patient characteristics as predictors. The models were internally validated using bootstrapping and externally validated using pneumonia patients discharged in 2014.ResultsThe median length of stay was 11 (interquartile range, 8–17) days. The following were significant predictors of prolonged length of stay (odds ratio >1.6): age ≥75 years, Barthel index score ≤6, fraction of inspired oxygen ≥35%, Japan Coma Scale score of 100–300, anemia, muscle wasting and atrophy, bedsores, dysphasia, and methicillin-resistant Staphylococcus aureus infection. Our validation models had a c-statistic of 0.78 (95% confidence interval, 0.77–0.79) and a calibration slope of 0.98.ConclusionsOur prediction models may help policymakers in developing strategies for the optimal management of community-acquired pneumonia patients with a focus on patients at a high risk of prolonged length of stay. |
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| Keywords: | Pneumonia Length of stay Prediction model Risk adjustment BMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0035" }," $$" :[{" #name" :" text" ," _" :" body mass index CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" confidence interval CAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" community-acquired pneumonia CRP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" C-reactive protein DPS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" Diagnosis Procedure Combination fraction of inspired oxygen JCS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" Japan Coma Scale LOS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" length of stay OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" odds ratio MRSA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" __text__" ," _" :" methicillin-resistant " },{" #name" :" italic" ," _" :" Staphylococcus aureus QIP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" Quality Indicator/Improvement Project pulse oximetry saturation |
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