Intensive Care Unit Usage for Pneumonia Doubles Length of Hospital Stay

David Bai

A recently released report using data from the National Hospital Care Survey (NHCS) verifies existing data on the prevalence of pneumonia in hospitalizations and emergency department (ED) visits and provides the first-ever data collection on diagnostic testing, length of stay (LOS), intensive care unit (ICU) stays, and mortality.

Pneumonia is a lung infection that can be linked to hospitalizations and mortality. In 2010, the National Hospital Discharge Survey reported 1.1 million inpatient hospitalizations for pneumonia in the United States, and in 2014, the National Hospital Ambulatory Medical Care Survey reported 1.5 million ED visits. In this report, inpatient data of pneumonia, collected from the NHCS in 2014, is analyzed for 94 hospitals, of which 88 hospitals also provided ambulatory claims. 
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The report from the NHCS included only patients with first-listed diagnoses of pneumonia, meaning that pneumonia was the main reason for their hospital visit. Of the pooled data collected, pneumonia hospitalizations accounted for 2.1% of all discharges, with 46.7% of the hospitalizations occurring in patients 65 years and older. Visits to the ED caused by pneumonia were 0.5% of all ED visits, with 46.1% of them occurring in patients under 15 years old.

Diagnostic testing and time spent hospitalized were other criteria that the NHCS analyzed. Through evaluating revenue codes, the NCHS reported that 75.3% inpatient hospitalizations involved microbiology testing, 41.2% involved a CT scan, 65.1% involved a chest x-ray, and 33.7% involved a pulmonary function test. Average LOS in the hospital was 4.2 days, with a shortest LOS of 3.1 days for patients under 15 years old and the longest LOS of 4.6 days in patients 65 years and older. ICU stays increased the overall time spent in the hospital by 50%, increasing LOS to 7.2 days.

NHCS also identified mortality caused by pneumonia. Among all the patients with first-listed diagnoses of pneumonia in the report, 2.6% died in the hospital. Morality rates at 30, 60, and 90 days were 4.2%, 2.2%, and 1.6%, respectively, with a mean age greater than 70 in all mortality groups. The mortality rate in patients 90 years and older with pneumonia amounts to 15.4%, doubling the mortality rate (7.8%) of patients 65 to 69 years old. Malignant neoplasms of unspecified part of bronchus or lung, and chronic obstructive pulmonary disease were the top 2 underlying causes of death.

The NHCS is the first survey that has been able to identify many statistics associated with pneumonia that previous surveys could not, such as ICU use, diagnostic services received, and 30-, 60-, and 90-day mortality. Data from the NHCS will prove to be an invaluable source for hospitals use in monitoring pneumonia and improving health outcomes, the authors of the report wrote.


Williams S, Gousen S, DeFrances C. National Hospital Care Survey demonstration projects: pneumonia inpatient hospitalizations and emergency department visits. Centers for Disease Control and Prevention. Updated August 24, 2018. Accessed September 5, 2018.
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