The Predictive Ability of a Partial Pneumonia Severity Index Score on the Receipt of Corticosteroids Outside of the Hospital for Pneumonia in Immunocompetent U.S. Adult Restricted; Files Only

Abstract

Community-acquired pneumonia is a leading cause of hospitalization and readmission in the United States. Despite high patient volumes and expenditures, pneumonia outcomes remain poor, with a third of hospitalized pneumonia patients dying within a year. Corticosteroids are a common treatment for pneumonia, with previous studies estimating that around 12% of pneumonia cases receive corticosteroids. Steroids can reduce inflammation, but they may also cause other complications like secondary infection and hyperglycemia. Current literature does not support steroid use for mild to moderate pneumonia but remains inconclusive for severe pneumonia. The American Thoracic Society updated clinical guidelines for pneumonia in late 2019, advising against steroid use, especially for mild to moderate cases. This study conducted a logistic regression on pooled cross-sectional data to determine how pneumonia severity impacted the probability of receiving a steroid outside of the hospital setting before the guidelines changed. Data from the Medical Expenditure Panel Survey (MEPS) was used, pooling MEPS data from 2000 to 2019. Demographic and comorbidity data were used to create a partial score based on the validated Pneumonia Severity Index (PSI). These scores were split up into quartiles, with quartile four representing the most severe pneumonia. After controlling for several covariates like sex, race/ethnicity, and other comorbidities, the two highest quartiles had significantly lower odds of receiving a steroid than the least severe cases (OR for PSI Q3: 0.52; OR for PSI Q4: 0.49, p<0.01). Non-Hispanic Black patients and Hispanic patients also had significantly lower odds of receiving a steroid as compared to non-Hispanic white patients (OR for non-Hispanic Black: 0.44; OR for Hispanic: 0.48, p<0.01). Males were much less likely to receive a steroid as compared to females, with an odds ratio of 0.71 (p<0.05). These results are significant because, while no patients should be getting steroids under new guidelines, less severe cases should not be receiving steroids more often than more severe cases according to the literature. Future work is needed to ensure that providers are presently following guidelines, and the disparities according to race/ethnicity and sex should be investigated further, especially to better understand how this may impact care outcomes. 

Table of Contents

Table of Contents

I.               Introduction 1

II.             Literature Review 3

III.           Methods 13

IV.           Results 22

V.             Discussion 29

VI.           References 34

VII.         Appendix 38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Community-acquired pneumonia Clinical guideline adherence Corticosteroids Pneumonia severity
Committee Chair / Thesis Advisor	Victoria Phillips, PhD, Emory University
Committee Members	Sara Turbow, MD, MPH, Emory University Peter Joski, MSPH, Emory University

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