P28发展新型高级临床医师主导的重症肺炎后续服务——一图不如千言

T. Armstrong, R. Gillott, T. Bongers, A. Ashraf
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摘要

在COVID-19大流行期间,英国胸科学会制定了针对所有严重COVID-19肺炎的国家指南(将我们的纳入标准定义为临床放射诊断、需氧量>35%、持续正压通气或机械通气),对所有COVID-19患者进行4 - 6周的随访,并在12周时进行影像学检查为了避免工作流程的重复,地区综合医院制定了与ICU联络的途径,以确保出院后4-6周的随访,12周的胸部x光检查和6个月的随访电话预约,目的是出院后返回社区或转诊进行进一步调查。我们总共随访了272名转介到我们服务的患者。在第一波(2020年4月至2020年7月)中,我们随访了117例患者,其中99例进行了随访胸部x光检查。出院后平均80.4(43-140)天进行胸片检查。在这些患者中,14%有残留变化,86%的临床胸片检查正常,33名(28%)患者在出院后平均168.4(91-209)天的随访中发现呼吸困难(由改良医学委员会研究呼吸困难评分量化),需要转诊进一步调查和呼吸内科医生随访。在第二波(2020年10月至2021年4月)中,我们随访了155例患者,其中133例进行了胸部x线检查,51例(38%)有残留病变。出院后平均88.7(32-120)天进行胸片检查,出院后平均150.9(92-172)天进行随访。迄今仅有35例患者随访(其余患者出院后未满6个月)。其中15例(42.8%)需要进一步调查。这一数据表明,我们为COVID-19重症肺炎患者提供了强有力的随访服务。重要的是,我们要仔细考虑谁被转介进行进一步的呼吸系统检查,因为我们的数据显示,胸部x光片的解决不一定与症状的解决相关,这对NHS服务的意义也很重要。英国胸科学会。英国胸科学会新冠肺炎临床影像学诊断患者呼吸随访指南[V1.2], 2020。https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/
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P28 Developing a novel advanced clinical practitioner led severe COVID-19 follow-up service – a picture is not always worth a thousand words
During the COVID-19 pandemic the British Thoracic Society produced national guidance advising for all severe COVID-19 pneumonia (defining our inclusion criteria as clinico-radiological diagnosis, oxygen requirements >35%, continuous positive pressure ventilation or mechanical ventilation) to have 4–6-week follow-up with all COVID-19 patients having imaging at 12 weeks.1 To avoid duplication of work streams, the district general hospital developed a pathway liaising with ICU to ensure follow-up 4–6 weeks post discharge, chest x-ray at 12 weeks and follow-up telephone appointment at six months with the aim of discharging back to the community or referring for further investigations. In total we followed up 272 patients who were referred to our service.In the first wave (April 2020 - July 2020) we followed up 117 patients of whom 99 had a follow-up chest X-ray. Chest x-rays were performed on average 80.4 (43–140) days post discharge. Of these patients, 14% had residual changes, with 86% having a clinic normal chest X-ray, with 33 (28%) requiring referral for further investigation and respiratory physician follow-up due to breathlessness (quantified by Modified Medical Council Research dyspnoea score) identified at follow-up clinic appointments, on average 168.4 (91–209) days post discharge.In the second wave (October 2020 – April 2021) we followed up 155 patients of whom 133 had a chest x-ray and 51 (38%) had residual changes. Chest x-rays were performed on average 88.7 (32–120) days post discharge and follow-up clinic appointments were on average 150.9 (92–172) days post discharge. Only 35 patients have been followed up to date (the remaining having not reached 6-months post discharge). Of these 15 (42.8%) required onwards referral for further investigation.This data shows that we have run a robust follow-up service for severe COVID-19 pneumonia patients. It is important that we think carefully about who is referred for further respiratory investigations as our data shows that chest x-ray resolution does not necessarily correlate with resolution of symptoms, and the implication for NHS services.British Thoracic Society. British Thoracic Society Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia [V1.2], 2020. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/
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