Does Antibiotic Timing Affect Accuracy of CAP Diagnosis?

The advent of the Centers for Medicare and Medicaid Services’ (CMS’s) national standard for treatment of community-acquired pneumonia (CAP) in U.S. hospitals has been the subject of much attention and controversy. The 2004 CMS standards inexplicably reduced the time to first antibiotic treatment from 8 hours to 4 hours after emergency department arrival. To assess whether this change affected the accuracy of ED diagnosis of CAP and whether misdiagnosis led to adverse patient outcomes, these authors retrospectively studied adult patients who were admitted to a community hospital with an ED diagnosis of CAP during a 6-month period before (255 patients) and after (293 patients) the change.

Because no standard definition for the diagnosis of CAP…