한빛사논문
- 조회452
Minjoung Monica Koo 1, Luke T A Mounce 2, Meena Rafiq 1, Matthew E J Callister 3, Hardeep Singh 4,5, Gary A Abel 2, Georgios Lyratzopoulos 1*
1Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Dept. of Behavioural Science and Health, Institute of Epidemiology & Health Care (IEHC), UCL, London, UK.
2Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK.
3Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
4Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA.
5Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
*Corresponding author : Georgios Lyratzopoulos
Abstract
Background Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation.
Methods We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General Practitioner-ordered chest X-ray/CT carried out within 2 weeks of symptomatic presentation, and variation by sociodemographic characteristic and relevant medical history using logistic regression. Additionally, among patients diagnosed with cancer we described time to diagnosis, diagnostic route and stage at diagnosis by guideline-concordant status.
Results In total, 22 560/162 161 (13.9%) patients with dyspnoea and 4022/8120 (49.5%) patients with haemoptysis received guideline-concordant imaging within the recommended 2-week period. Patients with recent chest imaging pre-presentation were much less likely to receive imaging (adjusted OR 0.16, 95% CI 0.14–0.18 for dyspnoea, and adjusted OR 0.09, 95% CI 0.06–0.11 for haemoptysis). History of chronic obstructive pulmonary disease/asthma was also associated with lower odds of guideline concordance (dyspnoea: OR 0.234, 95% CI 0.225–0.242 and haemoptysis: 0.88, 0.79–0.97). Guideline-concordant imaging was lower among dyspnoea presenters with prior heart failure; current or ex-smokers; and those in more socioeconomically disadvantaged groups.
The likelihood of lung cancer diagnosis within 12 months was greater among the guideline-concordant imaging group (dyspnoea: 1.1% vs 0.6%; haemoptysis: 3.5% vs 2.7%).
Conclusion The likelihood of receiving urgent imaging concords with the risk of subsequent cancer diagnosis. Nevertheless, large proportions of dyspnoea and haemoptysis presenters do not receive prompt chest imaging despite being eligible, indicating opportunities for earlier lung cancer diagnosis.
논문정보
- Research article
- 2023년 08월 (BRIC 등록일 2023-09-13)
- 국외 연구진
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