Management of patients presenting with haemoptysis to a Tertiary Care Italian Emergency Department: the Florence Haemoptysis Score (FLHASc).
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.
Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. simonevanni@alice.it.
Simone
S
Vanni
Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Simone
S
Bianchi
Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Sofia
S
Bigiarini
Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Claudia
C
Casula
General Laboratory Unit, Medical Services Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Marco
M
Brogi
Bronchoscopy Unit, Diagnostic and Operative Bronchology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Stefano
S
Orsi
Radiology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Manlio
M
Acquafresca
Interventional Pulmonology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Lorenzo
L
Corbetta
Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Stefano
S
Grifoni
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014218:Triage / Q000379:methods / Q000592:standards
Clinical score; Diagnosis; Emergency department; Haemoptysis; Prognosis