Background: Pneumonia is a leading cause of death in persons with spinal cord injuries and disorders (SCI/D), but little is known about guideline-based management for this disease in persons with SCI/D. Objectives: The goal of this study was to describe guideline-based medical care for community-acquired pneumonia (CAP) in veterans with SCI/D. Methods: A retrospective medical record review was conducted at 7 Department of Veterans Affairs (VA) medical centers where veterans with SCI/D and CAP between 2005 and 2008 were included. Outcomes assessed were receipt of blood or sputum culture, antibiotic timeliness, appropriateness of empiric antibiotic treatment, and vaccination. Results: In 70 patients, 77 CAP episodes occurred and 83.1% were treated in the inpatient setting. The average age was 70.0 years and 64.9% had tetraplegia. Sputum culture was completed in 24.7% and blood culture in 59.7% of cases. Of inpatients, 79.7% had antibiotic treatment within 8 hours and 45.1% received guideline-recommended empirical antibiotics. More than 90% of inpatients received antibiotic treatment within 3 days of presentation and 78.1% received recommended treatment. The rates of pneumococcal pneumonia (89.9%) and influenza (79.7%) vaccinations were high in CAP cases. Conclusions: Diagnostic testing and early guideline-recommended treatment is variable in veterans with SCI/D and CAP. However vaccination against influenza and pneumococcal pneumonia is high. Specific guidelines for management of CAP in SCI/D patients may be needed, which reflect the unique risk factors and needs of this population. These data can be used as a benchmark for improvements in care processes for treating and managing CAP in persons with SCI/D.
DiMarco AF, Kowalski KE, Geertman RT, Hromyak DR. Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-sponsored clinical trial. Part I: methodology and effectiveness of expiratory muscle activation. Arch Phys Med Rehabil 2009;90(5): 717–725
Lower thoracic spinal cord stimulation to restore cough in patients with spinal cord injury: results of a National Institutes of Health-sponsored clinical trial. Part I: methodology and effectiveness of expiratory muscle activation
, Arch Phys Med Rehabil
, vol. 90
(pg. 717
-725
) Smith BM, Evans CT, Kurichi JE, Weaver FM, Patel N, Burns SP. Acute respiratory tract infection visits of veterans with spinal cord injuries and disorders: rates, trends, and risk factors. J Spinal Cord Med 2007;30(4): 355–361
Acute respiratory tract infection visits of veterans with spinal cord injuries and disorders: rates, trends, and risk factors
, J Spinal Cord Med
, vol. 30
(pg. 355
-361
) Ragnarsson KT, Hall KM, Wilmot CB, et al. Management of pulmonary, cardiovascular and metabolic conditions after spinal cord injury. In: Stover SL, Delisa JA, Whiteneck GG, eds. Spinal Cord Injury: Clinical Outcomes for the Model Systems Gaithersburg, MD: Aspen; 1995: 79–99
Management of pulmonary, cardiovascular and metabolic conditions after spinal cord injury
, Spinal Cord Injury: Clinical Outcomes for the Model Systems
(pg. 79
-99
) DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80(11):1411–1419.
Recent trends in mortality and causes of death among persons with spinal cord injury
, Arch Phys Med Rehabil
, vol. 80
(pg. 1411
-1419
) National Spinal Cord Injury Statistical Center, University of Alabama, Birmingham. Facts & stats: spinal cord injuries facts and figures at a glance. February 2011. http://www.spinalcard.uab.edu/. http://www.spinalcard.uab.edu/
Niederman MS. Guidelines for the management of community-acquired pneumonia. Current recommendations and antibiotic selection issues. Med Clin North Am 2001;85(6):1493–1509.
Niederman MS. Guidelines for the management of community-acquired pneumonia. Current recommendations and antibiotic selection issues
, Med Clin North Am
, vol. 85
(pg. 1493
-1509
) Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin InfectDis 2000;31(2):347–382.
Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America
, Clin InfectDis
, vol. 31
(pg. 347
-382
) Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C; Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003;37(11):1405–1433.
Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults
, Clin Infect Dis
, vol. 37
(pg. 1405
-1433
) Mandell LA, Wunderink RG, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(suppl 2):S27–72
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults
, Clin Infect Dis
, vol. 44
(pg. S27
-72
) Evans CT, LaVela SL, Weaver FM, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2008;29(3):234–242.
Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder
, Infect Control Hosp Epidemiol
, vol. 29
(pg. 234
-242
) Pickering LK, Baker CJ, Freed GL, et al.; Infectious Diseases Society of America. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2009;49(6):817–840.
Infectious Diseases Society of America. Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America
, Clin Infect Dis
, vol. 49
(pg. 817
-840
) Advisory Committee on Immunization Practices (ACIP). Prevention and Control of Influenza Recommendations and Reports (no. RR-8. Vol 54). Centers for Disease Control and Prevention; Atlanta, GA: July 29. 2005. http://www.cdc.gov/mmwr/PDF/rr/rr5408.pdf. Accessed April 30, 2012. http://www.cdc.gov/mmwr/PDF/rr/rr5408.pdf
Goldstein B, Weaver FM, Hammond MC. New CDC recommendations: annual influenza vaccination recommended for individuals with spinal cord injuries. J Spinal Cord Med 2005;28(5):383–384.
New CDC recommendations: annual influenza vaccination recommended for individuals with spinal cord injuries
, J Spinal Cord Med
, vol. 28
(pg. 383
-384
) Weaver FM, Smith B, LaVela SL, et al. Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders. J Spinal Cord Med 2007;30(1):10–19.
Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders
, J Spinal Cord Med
, vol. 30
(pg. 10
-19
) Burns SP, Weaver FM, Parada JP, et al. Management of community-acquired pneumonia in persons with spinal cord injury. Spinal Cord 2004;42(8):450–458.
Management of community-acquired pneumonia in persons with spinal cord injury
, Spinal Cord
, vol. 42
(pg. 450
-458
) Jha AK, Wright SM, Perlin JB. Performance measures, vaccinations, and pneumonia rates among high-risk patients in Veterans Administration health care. Am J Public Health 2007;97(12):2167–2172.
Performance measures, vaccinations, and pneumonia rates among high-risk patients in Veterans Administration health care
, Am J Public Health
, vol. 97
(pg. 2167
-2172
) Evans CT, LaVela SL, Smith B, Wallace C, Goldstein B, Weaver FM. Response to the 2004–2005 influenza vaccine shortage in veterans with spinal cord injuries and disorders and their providers. J Spinal Cord Med 2007;30(1):20–26.
Response to the 2004–2005 influenza vaccine shortage in veterans with spinal cord injuries and disorders and their providers
, J Spinal Cord Med
, vol. 30
(pg. 20
-26
) LaVela SL, Cameron KA, Priebe M, Weaver FM. Development and testing of a vaccination message targeted to persons with spinal cord injuries and disorders. J Spinal Cord Med 2008;31(1):44–52.
Development and testing of a vaccination message targeted to persons with spinal cord injuries and disorders
, J Spinal Cord Med
, vol. 31
(pg. 44
-52
) Burns SP. Acute respiratory infections in persons with spinal cord injury. Phys Med Rehabil Clin N Am 2007;18(2):203–216.
Acute respiratory infections in persons with spinal cord injury
, Phys Med Rehabil Clin N Am
, vol. 18
(pg. 203
-216
)
This content is only available as a PDF.
