1.Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital
Ang Choon Seong ; Kelvin Beh Khai Meng ; Yeang Li Jing ; Chin Yuen Quan ; Khor Inn Shih ; Yoon Chee Kin ; Irfhan Ali bin Hyder Al
The Medical Journal of Malaysia 2020;75(4):390-
Introduction: Pneumonia continues to be as one of the top
causes of hospitalisations and deaths in Malaysia despite the
advancement in prevention and treatment of pneumonia. One
of the possible explanations is the frequent misdiagnosis of
pneumonia which had been reported elsewhere but such data is
not available locally.
Objectives: This is an audit project aiming to evaluate the
proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards
of Penang General Hospital based on their initial presentation
data, and their associated outcomes.
Methods: We reviewed the medical notes and initial chest
radiographs of 188 CAP patients who were admitted to
respiratory wards. Misdiagnosis was defined as cases which
lack suggestive clinical features and/or chest radiograph
changes. In-hospital mortality and length of stay (LOS) were
the outcomes of interest.
Results: The study found that 38.8% (n=73) of the hospitalised
CAP patients were misdiagnosed. The most common
alternative diagnosis was upper respiratory tract infection
(32.8%, n=24). There was no statistical difference between
misdiagnosis and CAP patients in the demographic and clinical
variables collected. In terms of outcomes, misdiagnosed
patients were discharged earlier (mean LOS= 3.5±3.28 days vs.
7.7±15.29 days, p=0.03) but the in-hospital mortality difference
was not statistically significant (p=0.07).
Conclusions: One third of our CAP admissions were
misdiagnosed. Although initial misdiagnosis of CAP in our
study did not show any increase in mortality or morbidity, a
proper diagnosis of CAP will be helpful in preventing
inappropriate prescription of antibiotics and unnecessary
admission.