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Pulmonary Procedures |

Reporting of Central Airway Obstruction on Radiology Reports and Impact on Bronchoscopic Airway Interventions and Patient Outcomes

Kassem Harris, MD; Kush Modi, MD; Abdul Hamid Alraiyes, MD; Kianna Menon; Samjot Dhillon, MD
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Roswell Park Cancer Institute, SUNY Buffalo, Buffalo, NY


Chest. 2015;148(4_MeetingAbstracts):820A. doi:10.1378/chest.2279410
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Abstract

SESSION TITLE: Interventional Pulmonology Posters II

SESSION TYPE: Original Investigation Poster

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

PURPOSE: The aim of this study is to compare the outcomes of patients with central airway obstruction (CAO) initially recognized by the radiology report or subsequently during assessment by interventional pulmonology.

METHODS: The medical records of patients who underwent initial advanced therapeutic bronchoscopy for CAO from August 2013 to September 2014 were retrospectively reviewed. Formal radiology reports of chest CT from 16 different medical and radiology centers were reviewed. Patient characteristics were reported as means, medians, and standard deviations for continuous variables; and as frequencies and relative frequencies for categorical variables.

RESULTS: Out of 42 patients, who underwent advanced bronchoscopy for planned therapeutic intervention, only 30 had radiology and pulmonology concordance about the airway findings. This is an agreement rate of 71.4% (95% CI: 56.7 - 83.3%) or a disagreement rate of 28.6% (95% CI: 16.7 - 43.3%). The radiology reports did not mention 31% of CAO on CT scans, and only one of these patients (7.7%) was not reported by initial interventional pulmonology assessment. The diagnosis of central airway obstruction was established during bronchoscopy with an average obstruction severity of 87.9 % (50-100%). There was a significant association between radiographic airway obstruction detection and age, time from referral to bronchoscopy, and time from CT imaging to bronchoscopy. Patients with CAO reported by radiologists were younger (mean age: 58 vs. 65, p=0.048). The mean time from CT imaging to bronchoscopy was significantly longer in patients with CAO not reported by the radiologists (33 vs. 13.5 days; p=0.011). The mean time from referral to bronchoscopy was also significantly longer in patients who have the CAO not reported by the radiologists (8 vs. 5.3 days; p=0.045). There was no significant association between radiographic reporting and clinical improvement. There were no statistically significant associations with overall survival.

CONCLUSIONS: Findings of central airway obstructions were not mentioned or described in a significant proportion of radiology reports. This resulted in significant delay in bronchoscopic airway management, which has the potential to provide symptomatic relief to many of these patients. This had no impact on overall survival.

CLINICAL IMPLICATIONS: Failure to describe CAO in radiology reports leads to significant delay in bronchoscopic airway intervention.

DISCLOSURE: The following authors have nothing to disclose: Kassem Harris, Kush Modi, Abdul Hamid Alraiyes, Kianna Menon, Samjot Dhillon

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