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Syndromic case definitions for lower respiratory tract infection (LRTI) are less sensitive in older age: an analysis of symptoms among hospitalised adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年6月7日

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  • Rachel Kwiatkowska,
  • Anastasia Chatzilena,
  • Jade King,
  • Madeleine Clout,
  • Serena McGuinness,
  • Nick Maskell,
  • Jennifer Oliver,
  • Robert Challen,
  • Matthew Hickman,
  • Adam Finn,
  • Catherine Hyams,
  • Leon Danon,
  • Anna Morley,
  • Amelia Langdon,
  • Anabella Turner,
  • Anya Mattocks,
  • Bethany Osborne,
  • Charli Grimes,
  • Claire Mitchell,
  • David Adegbite,
  • Emma Bridgeman,
  • Emma Scott,
  • Fiona Perkins,
  • Francesca Bayley,
  • Gabriella Ruffino,
  • Gabriella Valentine,
  • Grace Tilzey,
  • James Campling,
  • Johanna Kellett Wright,
  • Julia Brzezinska,
  • Julie Cloake,
  • Katarina Milutinovic,
  • Kate Helliker,
  • Katie Maughan,
  • Kazminder Fox,
  • Konstantina Minou,
  • Lana Ward,
  • Leah Fleming,
  • Leigh Morrison,
  • Lily Smart,
  • Louise Wright,
  • Lucy Grimwood,
  • Maddalena Bellavia,
  • Marianne Vasquez,
  • Maria Garcia Gonzalez,
  • Milo Jeenes-Flanagan,
  • Natalie Chang,
  • Niall Grace,
  • Nicola Manning,
  • Oliver Griffiths,
  • Pip Croxford,
  • Peter Sequenza,
  • Rajeka Lazarus,
  • Rhian Walters,
  • Robin Marlow,
  • Robyn Heath,
  • Rupert Antico,
  • Sandi Nammuni Arachchge,
  • Seevakumar Suppiah,
  • Taslima Mona,
  • Tawassal Riaz,
  • Vicki Mackay,
  • Zandile Maseko,
  • Zoe Taylor,
  • Zsolt Friedrich,
  • Zsuzsa Szasz-Benczur

摘要

Background

Lower Respiratory Tract Infections (LRTI) pose a serious threat to older adults but may be underdiagnosed due to atypical presentations. Here we assess LRTI symptom profiles and syndromic (symptom-based) case ascertainment in older (≥ 65y) as compared to younger adults (< 65y).

Methods

We included adults (≥ 18y) with confirmed LRTI admitted to two acute care Trusts in Bristol, UK from 1st August 2020- 31st July 2022. Logistic regression was used to assess whether age ≥ 65y reduced the probability of meeting syndromic LRTI case definitions, using patients’ symptoms at admission. We also calculated relative symptom frequencies (log-odds ratios) and evaluated how symptoms were clustered across different age groups.

Results

Of 17,620 clinically confirmed LRTI cases, 8,487 (48.1%) had symptoms meeting the case definition. Compared to those not meeting the definition these cases were younger, had less severe illness and were less likely to have received a SARS-CoV-2 vaccination or to have active SARS-CoV-2 infection. Prevalence of dementia/cognitive impairment and levels of comorbidity were lower in this group.

After controlling for sex, dementia and comorbidities, age ≥ 65y significantly reduced the probability of meeting the case definition (aOR = 0.67, 95% CI:0.63–0.71). Cases aged ≥ 65y were less likely to present with fever and LRTI-specific symptoms (e.g., pleurisy, sputum) than younger cases, and those aged ≥ 85y were characterised by lack of cough but frequent confusion and falls.

Conclusions

LRTI symptom profiles changed considerably with age in this hospitalised cohort. Standard screening protocols may fail to detect older and frailer cases of LRTI based on their symptoms.