Background Guidelines recommend urgent chest X-ray for newly presenting dyspnoea or haemoptysis but there is little evidence about their implementation. Methods We analysed linked primary care and hospital imaging data for patients aged 30+ years newly presenting with dyspnoea or haemoptysis in primary care during April 2012 to March 2017. We examined guideline-concordant management, defined as General Practitioner-ordered chest X-ray/CT carried out within 2 weeks of symptomatic presentation, and variation by sociodemographic characteristic and relevant medical history using logistic regression. Additionally, among patients diagnosed with cancer we described time to diagnosis, diagnostic route and stage at diagnosis by guideline-concordant status. Results In total, 22 560/162 161 (13.9%) patients with dyspnoea and 4022/8120 (49.5%) patients with haemoptysis received guideline-concordant imaging within the recommended 2-week period. Patients with recent chest imaging pre-presentation were much less likely to receive imaging (adjusted OR 0.16, 95% CI 0.14–0.18 for dyspnoea, and adjusted OR 0.09, 95% CI 0.06–0.11 for haemoptysis). History of chronic obstructive pulmonary disease/asthma was also associated with lower odds of guideline concordance (dyspnoea: OR 0.234, 95% CI 0.225–0.242 and haemoptysis: 0.88, 0.79–0.97). Guideline-concordant imaging was lower among dyspnoea presenters with prior heart failure; current or ex-smokers; and those in more socioeconomically disadvantaged groups. The likelihood of lung cancer diagnosis within 12 months was greater among the guideline-concordant imaging group (dyspnoea: 1.1% vs 0.6%; haemoptysis: 3.5% vs 2.7%). Conclusion The likelihood of receiving urgent imaging concords with the risk of subsequent cancer diagnosis. Nevertheless, large proportions of dyspnoea and haemoptysis presenters do not receive prompt chest imaging despite being eligible, indicating opportunities for earlier lung cancer diagnosis. Restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. For reusing these data, an application must be made directly to the Clinical Practice Research Datalink (CPRD; www.cprd.com).

中文翻译：

---

初级保健中新出现呼吸困难或咯血后及时胸部影像学检查的指南一致性：一项回顾性队列研究

背景指南建议对新出现的呼吸困难或咯血进行紧急胸部X光检查，但几乎没有证据表明其实施情况。方法 我们分析了 2012 年 4 月至 2017 年 3 月期间在初级保健中新出现呼吸困难或咯血的 30 岁以上患者的初级保健和医院影像数据。我们检查了指南一致的管理，定义为全科医生要求的胸部 X 光检查/ CT 在症状出现后 2 周内进行，并使用逻辑回归分析社会人口学特征和相关病史的变化。此外，在诊断为癌症的患者中，我们通过指南一致状态描述了诊断时间、诊断途径和诊断阶段。结果 总共有 22 560/162 161 (13.9%) 名呼吸困难患者和 4022/8120 (49.5%) 咯血患者在建议的 2 周内接受了符合指南的影像学检查。最近接受胸部影像学检查的患者接受影像学检查的可能性要小得多（对于呼吸困难，调整后的 OR 0.16，95% CI 0.14-0.18；对于咯血，调整后的 OR 0.09，95% CI 0.06-0.11）。慢性阻塞性肺疾病/哮喘病史也与指南一致性较低的几率相关（呼吸困难：OR 0.234，95% CI 0.225–0.242，咯血：0.88，0.79–0.97）。患有既往心力衰竭的呼吸困难患者的影像学符合指南要求较低；目前或戒烟者；以及那些处于社会经济弱势群体中的人。符合指南的影像学组在 12 个月内诊断出肺癌的可能性更高（呼吸困难：1.1% vs 0.6%；咯血：3.5% vs 2.7%）。结论 接受紧急影像检查的可能性与随后癌症诊断的风险一致。然而，尽管符合资格，但大部分呼吸困难和咯血患者并未接受及时胸部影像检查，这表明早期肺癌诊断的机会。这些数据的可用性受到限制，这些数据是在当前研究的许可下使用的，因此不公开。要重复使用这些数据，必须直接向临床实践研究数据链接（CPRD；www.cprd.com）提出申请。