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Internal and Emergency Medicine

, Volume 13, Issue 3, pp 397–404 | Cite as

Management of patients presenting with haemoptysis to a Tertiary Care Italian Emergency Department: the Florence Haemoptysis Score (FLHASc)

  • Simone VanniEmail author
  • Simone Bianchi
  • Sofia Bigiarini
  • Claudia Casula
  • Marco Brogi
  • Stefano Orsi
  • Manlio Acquafresca
  • Lorenzo Corbetta
  • Stefano Grifoni
EM - ORIGINAL

Abstract

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.

Keywords

Haemoptysis Diagnosis Prognosis Clinical score Emergency department 

Notes

Acknowledgements

The authors gratefully acknowledge the contribution of Sarah McLean in correcting the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© SIMI 2017

Authors and Affiliations

  • Simone Vanni
    • 1
    Email author
  • Simone Bianchi
    • 1
  • Sofia Bigiarini
    • 1
  • Claudia Casula
    • 1
  • Marco Brogi
    • 2
  • Stefano Orsi
    • 3
  • Manlio Acquafresca
    • 4
  • Lorenzo Corbetta
    • 5
  • Stefano Grifoni
    • 1
  1. 1.Emergency DepartmentAzienda Ospedaliero Universitaria CareggiFlorenceItaly
  2. 2.General Laboratory Unit, Medical Services DepartmentAzienda Ospedaliero Universitaria CareggiFlorenceItaly
  3. 3.Bronchoscopy Unit, Diagnostic and Operative Bronchology DepartmentAzienda Ospedaliero Universitaria CareggiFlorenceItaly
  4. 4.Radiology UnitAzienda Ospedaliero Universitaria CareggiFlorenceItaly
  5. 5.Interventional Pulmonology UnitAzienda Ospedaliero Universitaria CareggiFlorenceItaly

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