Introduction
Community-Acquired Pneumonia (CAP) is a leading cause of mortality globally. National guidelines advise HIV testing, legionella/pneumococcal antigen testing (LPAT) in non-mild CAP, and viral PCR (vPCR) during increased viral activity. We reviewed testing among inpatients with CAP over three winters to see if CoVid-19 impacted diagnostic behaviour.
Methods
Data were collected on patients admitted to the Royal Liverpool University Hospital with CAP in December 2020, 2021 and 2022. We assessed length of stay (LOS), and completion of CoVid, LPAT, HIV and vPCR testing. This was cross-referenced against UK government data on respiratory viral activity.
Results
Year-on-year admissions with CAP increased, but mean LOS reduced. 2022 had significantly increased rates of vPCR (6.3% v 31.6%, p<0.001) and LPAT (11.7% v 16.6%, p=0.04) compared to 2020/21, but lower rates of CoVid testing (93.5% v 43.9, p<0.001). December 2022 saw a rise in rates of influenza hospital admissions compared to 2020/21, and drop in CoVid hospital admissions.
| Dec 20(n=115) | Dec 21(n=360) | Dec 22(n=392) | |
| Average LOS,days | 10.9 | 10.0 | 5.3 |
| CoVid(%) | 109(95) | 335(93) | 172(44) |
| vPCR(%) | 14(12) | 16(4) | 124(32) |
| HIV(%) | 14(12) | 30(8) | 38(10) |
| LPAT(%) | 13(11) | 43(12) | 65(17) |
| Influenza admissions(/100000) | 0.01 | 0.23 | 10.17 |
| CoVid admissions(/100000) | 17.69 | 11.07 | 9.67 |
Conclusion
In years with high rates of CoVid admissions, patients with CAP were less likely to receive non-CoVid investigations, potentially reflecting early diagnostic closure. Conversely, CoVid testing dropped in 2022, despite ongoing high hospitalisation rates. These data suggest diagnostic behaviours vary greatly based on circulating viral patterns, and further research is warranted.