We appreciate the comments by Drs Strålin and Holmberg regarding our recent article.1 We acknowledge that the study of long-term pneumonia prognosis and cause of death by Hedlund et al2 should have been cited in our article. However, it should be noted that their study followed up patients with CAP for an average of 31 months and assigned cause of death using information obtained from a death registry, not by investigator review of the clinical circumstances leading to death. In the study by Hedlund et al, only 25% of deaths registered pneumonia as the primary or secondary cause of death. Only a small number of patients were available in their sample; 51 (21%) of 241 patients died and relatively small numbers of patients (n<2) were listed in most of the cause of death categories. Previous studies have demonstrated that cause of death information from death registries is often inaccurate, so it is unclear what their results would have been with investigator review and a larger patient cohort.3 Therefore, we believe that our study presents novel information regarding the causes of death for patients with CAP.
Mortensen E, Obrosky DS, Fine MJ. Causes of Death for Patients With Community-Acquired Pneumonia—Reply. Arch Intern Med. 2002;162(21):2492. doi: