Characterizing Pediatric Aspiration Pneumonia: Diagnostic Gaps and Stewardship Opportunities.

Background and objectives: Aspiration pneumonia is a common cause for hospitalization, especially in children with medical complexity, yet there are no standard definition or clinical practice guidelines for the condition. Our objectives were to assess the validity of the aspiration pneumonia billing code and to describe the demographics, presenting symptoms, diagnostic results, and outcomes of children hospitalized with this condition.

Methods: We performed a retrospective cross-sectional analysis of 200 patients hospitalized with an International Classification of Diseases, tenth revision (ICD-10) diagnosis of aspiration pneumonia from 2016 to 2021. We conducted a standardized medical record review to identify children with a clinician diagnosis of aspiration pneumonia and collected data on patient and hospitalization characteristics across 4 subgroups defined by a combination of clinical and radiographic features.

Results: Among 200 patients identified by ICD-10 code, 138 (69%) also had a clinician diagnosis of aspiration pneumonia. For these 138 patients, the mean age was 8.4 years (SD, 7), and most had an underlying medical complexity. Diagnostic testing, antibiotic selection, and hospitalization outcomes were similar across definition subgroups. Only 18 patients (13%) had aspiration risk factors, fever, and a probable focal opacity on chest imaging at diagnosis.

Conclusions: We observed significant variability in presenting symptoms and diagnostic testing results among patients assigned a clinician diagnosis of aspiration pneumonia. Our study underscores the need for a standardized clinical definition, improved diagnostic criteria, and evidence-based treatment guidelines to optimize clinical care for this patient population.