Bronchoscopy to assess patients with hemoptysis: which is the optimal timing?
Abstract Background Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods We performed a secondary analysis of an observational...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12890-019-0795-9 |
| _version_ | 1818978673056808960 |
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| author | Michele Mondoni Paolo Carlucci Giuseppe Cipolla Alessandro Fois Stefano Gasparini Silvia Marani Stefano Centanni Giovanni Sotgiu |
| author_facet | Michele Mondoni Paolo Carlucci Giuseppe Cipolla Alessandro Fois Stefano Gasparini Silvia Marani Stefano Centanni Giovanni Sotgiu |
| author_sort | Michele Mondoni |
| collection | DOAJ |
| description | Abstract Background Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53–76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration ClinicalTrials.gov (identifier: NCT02045394). |
| first_indexed | 2024-12-20T16:47:22Z |
| format | Article |
| id | doaj.art-a69af61076574b16a471da244814f38d |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-20T16:47:22Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-a69af61076574b16a471da244814f38d2022-12-21T19:32:53ZengBMCBMC Pulmonary Medicine1471-24662019-02-011911610.1186/s12890-019-0795-9Bronchoscopy to assess patients with hemoptysis: which is the optimal timing?Michele Mondoni0Paolo Carlucci1Giuseppe Cipolla2Alessandro Fois3Stefano Gasparini4Silvia Marani5Stefano Centanni6Giovanni Sotgiu7Department of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo HospitalDepartment of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo HospitalASST Lodi, UOC PneumologiaLung Disease Unit, Department of Medical, Surgical, Experimental Sciences, University of SassariDepartment of Biomedical Sciences and Public Health, Università Politecnica delle MarcheASST Mantova, Dipartimento Cardio-Toraco-Vascolare, Unità Operativa di Pneumologia e UTIRDepartment of Health Sciences, Respiratory Unit, ASST Santi Paolo e Carlo, Università degli Studi di Milano, San Paolo HospitalClinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of SassariAbstract Background Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53–76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration ClinicalTrials.gov (identifier: NCT02045394).http://link.springer.com/article/10.1186/s12890-019-0795-9BronchoscopyHemoptysisLung cancerBronchiectasisPneumonia |
| spellingShingle | Michele Mondoni Paolo Carlucci Giuseppe Cipolla Alessandro Fois Stefano Gasparini Silvia Marani Stefano Centanni Giovanni Sotgiu Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? BMC Pulmonary Medicine Bronchoscopy Hemoptysis Lung cancer Bronchiectasis Pneumonia |
| title | Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? |
| title_full | Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? |
| title_fullStr | Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? |
| title_full_unstemmed | Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? |
| title_short | Bronchoscopy to assess patients with hemoptysis: which is the optimal timing? |
| title_sort | bronchoscopy to assess patients with hemoptysis which is the optimal timing |
| topic | Bronchoscopy Hemoptysis Lung cancer Bronchiectasis Pneumonia |
| url | http://link.springer.com/article/10.1186/s12890-019-0795-9 |
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