Dx accuracy for CAP

Lalit Kalra drlalitkalra at GMAIL.COM
Tue Nov 26 16:10:18 UTC 2013


I am an Infectious Disease physician and I agree with over use of Sepsis
and CAP. I believe Sepsis term as such needs to be redefined. What I have
seen is even though physician don't want use term "sepsis" hospital and
case management tend to force admitting physician use sepsis if they have 2
of 4 SIRS criteria and possible source of infection. As rightly mentioned
before any patient presenting with fever will have tachycardia, and may
have slightly elevated WBC count, and that puts them in SIRS category and
of course if you are suspecting infection, case management will push for
writing sepsis as that increases DRG and reimbursement for Hospitals.

Pneumonia is again a "waste basket" diagnosis any one presenting with
respiratory symptoms and if have pulmonary infiltrates gets a diagnosis of
CAP by ED which is rarely revoked by admitting physician. I am usually
consulted when they are about discharge and admitting physician is not sure
if patient needs antibiotics upon discharge. Similarly any hospitalized
patient who is on Vent get a diagnosis of VAP if they have pulmonary
infiltrates on CXR, doesn't matter what is etiology of these infiltrates.

Lalit Kalra,MD
Consultants in Infectious Diseases.
St. Petersburg, FL


On Tue, Nov 19, 2013 at 7:43 AM, Robert M Centor <rcentor at uab.edu> wrote:

>   My pet peeve as an academic hospitalist is the “diagnosis” of CAP
> (community acquired pneumonia).  Once I hear that phrase I immediately
> become skeptical.  CAP has seemingly become a waste basket diagnosis for
> dyspnea and an abnormal CXR.  I love collecting  and presenting patient
> stories that start as community acquired pneumonia.  In preparing to more
> formally study this topic, I have spent much time thinking about the
> problem.   Just yesterday I recalled this paper.  I have not seen it in the
> diagnostic error literature previously, and thought I would share it with
> the group.  If you know of other similar articles, I would greatly
> appreciate the references.
>
>  Given the lower diagnostic accuracy on CAP, I urge all physicians to be
> skeptical of the diagnosis, until collecting appropriate clinical
> information to support the diagnosis.
>
>  http://archinte.jamanetwork.com/article.aspx?articleid=413982 (article
> available for free)
>
>  1. Welker JA, Huston M, McCue JD. Antibiotic timing and errors in
> diagnosing pneumonia. Arch Intern Med. 2008 Feb 25;168(4):351–6.
>  ==============
>
>  Robert M Centor, MD, FACP
>
>  Regional Dean, UAB Huntsville Regional Medical Campus
> 301 Governors Drive
> Huntsville, AL 35801
>
>  Office: 256-539-7757
> Fax: 256-551-4451
>
>  Chair-Elect, ACP Board of Regents
>
>  Professor, General Internal Medicine
> UAB
>  FOT 720
> 1530 3rd Ave S
> Birmingham, AL 35294-3407
> Office: 205-975-4889
>
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-- 
Lalit Kalra,MD








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