Mridula Rajwani

Introduction: Patients with respiratory infection-associated changes on chest X-ray often have follow-up chest X-rays (CXRs) to exclude malignancy. In the UK, same day emergency care (SDEC) units have been developed to manage patients needing urgent hospital care on an ambulatory basis. The yield of findings and benefit from follow-up CXRs in this population is unknown. We report the non-malignant and malignant findings from our cohort of SDEC patients.
Methods: We performed a retrospective service evaluation of CXRs for adult patients who attended our SDEC between 6/1/2020 and 25/9/2023, identifying CXRs arranged as follow-up for infection-related findings and assessing outcomes stratified by lung malignancy-associated risk factors.
Results: Of 27,336 CXR requests from our SDEC unit, we identified 419 follow-up CXRs. From these, 341 follow-up CXRs were done to assess resolution of infection-related changes; 304 (89%) showed resolution and 37 (11%) showed persistent changes. Further investigation of persistent changes identified two malignancies and several non-malignant conditions including 7 cases of interstitial lung disease, 2 requiring ongoing respiratory follow up. Both patients with cancer were over 50 with risk factors.
Conclusions: The small number of malignancies detected in follow-up CXRs in SDEC patients support risk factor-based targeting of CXRs although non-malignant findings may benefit some patients.