Pettit Nicholas R, Horner Diane, Freeman Sara, Rieger Karen
Department of Emergency Medicine, Indiana University, Indianapolis, IN, United States of America.
Eskenazi Health, Lung Cancer Screening Program, Indianapolis, IN, United States of America.
Am J Emerg Med. 2024 May;79:157-160. doi: 10.1016/j.ajem.2024.02.019. Epub 2024 Feb 20.
The goal of this study is to demonstrate the feasibility of referring patients for lung cancer screening (LCS) from the emergency department (ED) as a method to increase the uptake of LCS.
This is a single-arm pilot study at a large safety-net ED. ED LCS-eligible patients were offered a referral to our LCS clinic upon ED discharge. The primary outcome was the frequency at which patients connected with the LCS clinic.
During the study period, 105 patients were approached; 26 (24.8%) participated. Reasons for non-enrollment include 29 (27.6%) who were not interested in research, 10 (9.5%) who did not speak English, and 40 (38.1%) who did not meet the pack-years criteria. Seventeen patients (65.4%, 17/26) connected with the LCS clinic, with 10 (38.5%) having been seen in the clinic and received a low dose computed tomography (LDCT) scan. Of the 17 that were connected with the clinic, 7 (26.9%) had a non-LDCT chest CT scan in the past year. Of those that were not seen in the clinic (n = 9), 4 (44.4%) were unreachable via 3 phone calls and a post-marked letter, and 3 (33.3%) did not attend the scheduled appointment, and 2 (22.2%) were delayed due to COVID-19. Of those that had CT scans over the study period (n = 17), 0 scans were normal, one patient (5.9%) had asymptomatic lung cancer, 7 (41.2%) had pulmonary nodules, 11 (64.7%) had emphysema, and 9 (52.9%) had coronary artery disease.
This pilot study suggests the feasibility and suggests initial indications of the efficacy of referring ED patients for LCS.
本研究的目的是证明将急诊科（ED）患者转诊进行肺癌筛查（LCS）作为一种提高LCS接受率的方法的可行性。
这是一项在大型安全网急诊科进行的单臂试点研究。符合ED-LCS条件的患者在ED出院时被转介到我们的LCS诊所。主要结果是患者与LCS诊所联系的频率。
在研究期间，共接触了105名患者；26名（24.8%）参与。未入组的原因包括29名（27.6%）对研究不感兴趣、10名（9.5%）不会说英语以及40名（38.1%）不符合吸烟包年标准。17名患者（65.4%，17/26）与LCS诊所取得联系，其中10名（38.5%）在诊所就诊并接受了低剂量计算机断层扫描（LDCT）。在与诊所取得联系的17名患者中，7名（26.9%）在过去一年进行了非LDCT胸部CT扫描。在未在诊所就诊的患者中（n = 9），4名（44.4%）通过3次电话和一封挂号信无法联系到，3名（33.3%）未参加预定预约，2名（22.2%）因COVID-19而推迟。在研究期间进行CT扫描的患者中（n = 17），0次扫描结果正常，1名患者（5.9%）患有无症状肺癌，7名（41.2%）有肺结节，11名（64.7%）有肺气肿，9名（52.9%）有冠状动脉疾病。
这项试点研究表明了将ED患者转诊进行LCS的可行性，并初步显示了其有效性。
