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Abstract
Background Southmead Hospital is a large teaching Hospital in the South West of England. GP two week wait (TWW) referrals to the respiratory department are sent via a standardised proforma with one of a number of reasons for referral selected. We conducted this project both to evaluate how we are currently investigating patients referred with haemoptysis and to identify whether our diagnostic pathway for patients for these patients could be optimised. We were particularly interested as to whether bronchoscopy is diagnostically helpful in this cohort of patients.
Methods We looked at all TWW referrals between 13/6/13 and 2/4/15 (825 referrals) and selected those who were referred for haemoptysis (110 patients). The clinical course of these patients was tracked retrospectively by looking at our electronic record system and clinical letters.
Results Overall 109 of the 110 patients identified had a CT scan – this was normal in 31 patients. In the remainder of cases the CT was suggestive of malignancy in 38 of the 78 abnormal scans. The remainder of CT scans had positive findings that were not suggestive of malignancy. Of the 31 patients who had a normal scan, 22 patients underwent bronchoscopy. 40 patients had abnormal CT scan that were not suggestive of malignancy. 25 of these patients went on to have bronchoscopy All bronchoscopies were either normal or showed non specific findings.16 patients who had an eventual diagnosis of lung malignancy had an initial CT scan suggestive of malignancy.
Conclusion Our project demonstrates that currently 58% of patients referred with haemoptysis via the TWW system go on to have a bonchoscopy. In our cohort of patients all bronchoscopies were either normal or showed non-specific changes. All patients with lung malignancy had a prior CT that was suggestive of malignancy and did not require a bronchoscopy other than as a potential means of obtaining tissue. We suggest that bronchoscopy may not be necessary in patients referred with haemoptysis who have a normal CT scan. We feel this will change our local practice and may enable us to better target this investigation to patients who will benefit from it.