Background and importance 

Because of its associated high morbidity and mortality, early identification and treatment of community-acquired pneumonia (CAP) are essential.

Objectives 

To investigate age- and sex-related differences in clinical symptoms, radiologic findings and outcomes in patients presenting to the emergency department (ED) with CAP.

Design 

Retrospective cohort study.

Setting and participants 

Patients admitted to one Swiss ED with radiologically confirmed CAP between 1 January 2017 and 31 December 2018.

Outcome measures and analysis 

Primary aim was to evaluate differences in clinical and radiologic presentation of men vs. women and patients >65 years vs. <65 years with CAP. Secondary outcomes were age- and sex-related differences in terms of Pneumonia Severity Index (PSI) risk class, need for ICU referral, mechanical ventilation, in-hospital mortality, 30-day readmission and 180-day pneumonia recurrence.

Main results 

In total 467 patients with CAP were included. 211 were women (45%). 317 were ≥65 years (68%), of which 145 were women (46%). Older patients less commonly reported chest pain (13 vs. 27%; effect size 14%; 95% CI, 0.07–0.23), fever (39 vs. 53%, effect size 14%; 95% CI, 0.05–0.24), chills (6 vs. 20%; effect size 14%; 95% CI, 0.08–0.0.214), cough (44 vs. 57%; effect size 13%; 95% CI, 0.03–0.22), headache (5 vs. 15%, effect size 10%, 95% CI, 0.04–0.17) and myalgias (5 vs. 19%; effect size 14%; 95% CI, 0.07–0.21). However, 85% of patients with no symptoms were ≥65 years. PSI was lower in women [95 (SD 31) vs. 104 (SD 31); 95% CI, −14.44 to 2.35] and sputum was more common in men (32 vs. 22%; effect size 10%; 95% CI, −0.18 to −0.02). Raw mortality was higher in elderly patients [14 vs. 3%; odds ratio (OR), 4.67; 95% CI, 1.81–12.05], whereas it was similar in men and women (11 vs. 10%; OR, 1.22; 95% CI, 0.67–2.23).

Conclusion 

Patients, less than 65 years with CAP presenting to the ED had significantly more typical symptoms such as chest pain, fever, chills, cough, headache and myalgias than those being above 65 years. No relevant differences between men and women were found in clinical presentation, except for PSI on admission, and radiologic findings and neither age nor sex was a predictor for mortality in CAP.

中文翻译：

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就诊于急诊室的社区获得性肺炎的年龄和性别差异：一项回顾性队列研究

背景和重要性 

由于其相关的高发病率和死亡率，社区获得性肺炎 (CAP) 的早期识别和治疗至关重要。

目标 

调查就诊于急诊科 (ED) 的 CAP 患者在临床症状、放射学发现和结果方面与年龄和性别相关的差异。

设计 

回顾性队列研究。

设置和参与者 

2017 年 1 月 1 日至 2018 年 12 月 31 日期间，一名经放射学证实的 CAP 入住瑞士急诊室的患者。

结果测量和分析 

主要目的是评估男性与女性以及 >65 岁与 <65 岁的 CAP 患者在临床和放射学表现上的差异。次要结果是肺炎严重程度指数 (PSI) 风险等级、ICU 转诊需求、机械通气、院内死亡率、30 天再入院和 180 天肺炎复发方面的年龄和性别差异。

主要结果 

总共包括 467 名 CAP 患者。211 名女性 (45%)。317 人≥65 岁 (68%)，其中 145 人为女性 (46%)。老年患者较少报告胸痛（13% 对 27%；效应量 14%；95% CI，0.07-0.23）、发烧（39 对 53%，效应量 14%；95% CI，0.05-0.24），发冷（6 对 20%；效应量 14%；95% CI，0.08-0.0.214）、咳嗽（44 对 57%；效应量 13%；95% CI，0.03-0.22）、头痛（5 对 0.03-0.22） . 15%，效应量 10%，95% CI，0.04-0.17）和肌痛（5 对 19%；效应量 14%；95% CI，0.07-0.21）。然而，85% 的无症状患者年龄≥65 岁。女性的 PSI 较低 [95 (SD 31) vs. 104 (SD 31)；95% CI，-14.44 至 2.35] 和痰液在男性中更常见（32% 对 22%；效应量 10%；95% CI，-0.18 至 -0.02）。老年患者的原始死亡率更高 [14% 对 3%；优势比（OR），4.67；95% CI, 1.81–12.05],

结论 

与 65 岁以上的患者相比，65 岁以下的 CAP 患者出现在急诊室的典型症状明显更多，例如胸痛、发烧、发冷、咳嗽、头痛和肌痛。除了入院时的 PSI 和放射学检查结果外，在临床表现上没有发现男性和女性之间的相关差异，年龄和性别都不是 CAP 死亡率的预测因子。