Background Asbestos related lung disease consists of a spectrum of disorders, ranging from benign pleural plaques to mesothelioma. In patients with a history of asbestos exposure, radiological imaging can be used to make a diagnosis. Accurate reporting of asbestos related lung disease is of vital importance to national statistics and affected individuals and their families may claim compensation from the government under the industrial injuries disablement benefit scheme. This study set out to examine the adequacy of reporting of asbestos related lung disease to HM coroner in a large teaching hospital.
Methods A retrospective case-note analysis was performed for all deaths occurring whilst under the care of respiratory physicians at a large teaching hospital from July 2012 to February 2013. Electronic patient records and radiological imaging for all of these patients was examined for any evidence of pleural plaques, pleural thickening, asbestos-related lung cancer, asbestosis or mesothelioma. A radiologist had reported all radiological imaging. Records were then cross-referenced with information held by the bereavement care office to identify whether these deaths had been referred to the coroner.
Results 115 patients were identified. Of these, 16 had radiological evidence of asbestos related lung disease; 4 on chest x-ray and 12 on CT. 2 of these patients had biopsy confirmed mesothelioma. Both mesothelioma cases were referred to the coroner and a coroners’ inquest subsequently performed. Only 60% of CT proven asbestos related disease and 30% of patients with CXR changes were referred. Of the cases not referred to the coroner 3 patients had bilateral pleural thickening on CXR and 4 patients had CT proven evidence of widespread pleural thickening.
Conclusions This study demonstrates that whilst reporting of malignant asbestos-related pleural disease to the coroner is adequate, there is room for improvement in the reporting of more benign disease. The authors propose that improved education of junior doctors may increase awareness of the importance of asbestos related lung disease, having far-reaching implications for both national statistics and those affected by these conditions.
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