Management of patients presenting with haemoptysis to a Tertiary Care Italian Emergency Department: the Florence Haemoptysis Score (FLHASc)
| Autor: | Simone Bianchi, Sofia Bigiarini, Manlio Acquafresca, Simone Vanni, Claudia Casula, Marco Brogi, Stefano Orsi, Stefano Grifoni, Lorenzo Corbetta |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Hemoptysis Vital signs law.invention Decision Support Techniques Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine law Internal Medicine medicine Odds Ratio Humans Aged Retrospective Studies Chi-Square Distribution business.industry Incidence (epidemiology) Incidence Disease Management 030208 emergency & critical care medicine Retrospective cohort study Emergency department Odds ratio Middle Aged Intensive care unit Triage Radiography Logistic Models 030228 respiratory system Italy Emergency Medicine Female business Emergency Service Hospital Chi-squared distribution |
| Zdroj: | Internal and emergency medicine. 13(3) |
| ISSN: | 1970-9366 |
| Popis: | We analysed the clinical features and diagnostic workup of patients presenting with haemoptysis to an Italian teaching hospital to derive an easy-to-use clinical score to guide risk stratification and initial management in the emergency department (ED). We retrospectively reviewed clinical records of consecutive patients with haemoptysis over 1 year. A pre-specified set of variables, including demographic data, vital signs, type of expectorate (pure blood vs. blood-streaked sputum), comorbidities, and diagnostic tests and treatments was originally registered. The primary outcome was a composite of any of the following: death from any cause, invasive or non-invasive ventilation, Intensive Care Unit admission, blood transfusions or invasive haemostatic procedures. We investigated associations between the pre-specified clinical variables and the primary outcome using a logistic regression analysis. Finally, we derived a score (the Florence Haemoptysis Score, FLHASc) giving a proportional weight to each variable according to the Odds Ratios (OR). We included 197 patients with a median age of 60 years. The first radiological study was a plain chest X-ray in 128 patients (65%). For 33 (17%) patients, a chest computer tomography (CT scan) was the first radiological study. The most common diagnosis was lung malignancy (19% of cases). The diagnosis remained undetermined in one-third of patients. The primary outcome was met by 11.2% of the study population. Systolic blood pressure 100 mmHg (OR 9.7), a history of malignancy (OR 3), the expectoration of pure blood (OR 2.8), and more than 2 episodes of haemoptysis in the prior 24 h (OR 2.5) are found as independent predictors of the primary outcome. The FLHASc ranges from 0 to 6 with a prognostic accuracy of 78% (IC 95%, 68-88%). The primary outcome incidence is 2.4% (IC 95%, 0.2-8.2%) in patients with a FLHASc equal to zero (n = 85, 43%) versus 13.4% (IC 95% 7.8-21.1%) in patients with a FLHASc 0 (p 0.01). Among patients with a FLHASc equal to zero, a negative chest X-ray study identifies patients who may be safely discharged. Patients who presented to the ED with haemoptysis experience a heterogeneous management. We derive a simple clinical prognostic score that may rationalize their diagnostic workup. |
| Databáze: | OpenAIRE |
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