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Chest Infections |

Chest Radiographic Follow-up of Patients With Community-Acquired Pneumonia in a Teaching Hospital in Singapore

Jennifer Boon Wee Lua; Sumit Kumar Sonu; Aaron Qi Han Chua; Carmen Jia Wen Kam; Jansen Meng Kwang Koh; Teck Boon Low, MBChB
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Changi General Hospital, Singapore, Singapore


Chest. 2015;148(4_MeetingAbstracts):118A. doi:10.1378/chest.2264413
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Abstract

SESSION TITLE: Chest Infections Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Patients who have Community Acquired Pneumonia (CAP) are followed up commonly with a CXR for radiological resolution. This is consistent with the British Thoracic Society Guidelines which recommends a 6-week follow up chest X-ray (CXR). Previous studies have shown that 2.0%-9.2% of patients with CAP were eventually found to have lung cancer on follow up. The aim of this study is to determine the outcomes on following up in-patients with CAP.

METHODS: All patients admitted with a diagnosis of CAP between January-April 2010 were included in this retrospective analysis. Exclusion criteria included age less than 21 years, pregnant women, prisoners, cancer diagnosis at presentation and those who died in hospital. The clinical and radiologic outcomes were reviewed 2 years after admission.

RESULTS: A total of 365 patients with CAP were included in this study. About a third of patients, 139 (38.1%), returned for a CXR follow-up at a median interval of 4 weeks (IQR 4 - 6 weeks). The majority, 132 (95.0%), of patients who had CXR follow-up showed resolution of pneumonia. Five (3.6%) patients had worsening CXR at follow-up. Of these, 3 (2.2%) were found to have lung cancer and 2 (1.4%) were found to have pulmonary tuberculosis (PTB) within the 2 year period. All 3 patients with lung cancer were >50 years old. Two were heavy smokers with a greater than 30-pack-year history. One was a non-smoker who had recurrent admissions for pneumonia.

CONCLUSIONS: The majority of patients admitted for CAP may not require a follow up CXR. However, patients with a history of heavy smoking, age> 50 years and history of recurrent pneumonia should be followed up as these clinical factors appears to be risk factors for lung cancer for patients admitted for CAP.

CLINICAL IMPLICATIONS: Follow up CXR may not be required for all patients with CAP especially in patients with no risk factors for lung cancer.

DISCLOSURE: The following authors have nothing to disclose: Jennifer Boon Wee Lua, Sumit Kumar Sonu, Aaron Qi Han Chua, Carmen Jia Wen Kam, Jansen Meng Kwang Koh, Teck Boon Low

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