-Community-acquired pneumonia (CAP) is the most common reason for acute admission to hospital and the fourth most common cause of death in the UK. It is important to identify patients with severe pneumonia and the worst prognosis. We conducted this study to validate a rule designed to do this devised in New Zealand. CAP was defined by evidence of new shadowing on the chest X-ray and clinical features of pneumonia. A standardised proforma was completed documenting clinical features and investigation results. Severe pneumonia was identified by two or more of the following: confusion; respiratory rate 30/min; diastolic blood pressure 60 mmHg; urea >7 mmol/l. One hundred patients (mean age 58.8 years) were included; 32 satisfied the rule. Seven died, all of whom satisfied the rule. Ten patients received intensive care, including six who died. Of 11 patients who died and/or received intensive care, nine satisfied the rule. The sensitivity and specificity of the rule for predicting death and/or intensive care were 82% and 73% respectively.

Background The incidence of malignant pleural effusions (MPE) is increasing and overall prognosis remains poor. In-dwelling pleural catheters (IPCs) relieve symptoms, but increase the risk of pleural infection. We reviewed survival times of cases of pleural infection in patients with IPCs for MPE from 6 UK centres. Methods Baseline data were collected for all IPC insertions from 1/1/05 to 31/1/14. Survival times were analysed by underlying tumour. Results were compared with national data, and with data from a cohort of 789 patients with MPE (the LENT cohort). LENT scores were used to calculate individual predicted life expectancy, which was compared with actual survival. Results Of 672 IPCs inserted across 6 centres during the study period, 25 patients (3.6%) experienced pleural infection. 19/25 were male,median age 69 (range 35-79). 12/25 had mesothelioma, 8/25 lung cancer, 3/25 breast cancer, 1/25 lymphoma and 1/25 thyroid cancer. 18/25 had a performance status of 0-1, and 19/25 received oncological treatment.Survival with MPE and pleural infection compared favourably with the LENT cohort (see figure 1). Median survival with mesothelioma and pleural infection was 753 days (95% confidence interval 446-1089) compared with 339 days in the LENT cohort (95% CI 267-442) and less than 365 days in nationally reported data. Patients with lung cancer and pleural infection also outlived their LENT counterparts; median survival of 138 days (95% CI 62-479) versus 74 days (95% CI 60-90). Patients with breast cancer had similar survival times (167 vs 192 days).

Can the detection rate of flexible bronchoscopy for lung cancer be increased by a series of simple quality improvement measures?Bronchoscopy . Prior computed tomography availability was associated with a higher diagnostic yield that did not reach statistical significance. Logistic regression analysis identified tumour visibility, year of study, use of transbronchial needle aspiration and pathologist identity as independent predictors of a positive diagnosis.A significant increase in bronchoscopic detection rate for malignancy occurred in association with a number of simple improvement measures.

TBNA histology specimens using both 21G and 22G needles in confirmed primary lung adenocarcinoma. Methods A prospective analysis was performed on 250 consecutive patients undergoing EBUS-TBNA between 2009 and 2013. 21G or 22G needles (Olympus ViziShot, NA-201SX-4021 and NA-201SX-4022) were used by operator discretion. A minimum of 2 passes were carried out per nodal station. Samples were fixed in formalin and prepared for histopathological analysis. The proportion of confirmed primary lung adenocarcinoma samples in which EGFR mutation testing was feasible was determined. Results Primary lung adenocarcinoma was confirmed in 45 patients (18%). EGFR mutation analysis was attempted in 35 of these patients and was possible in 34 (97.1%). EGFR mutation was present in 3 patients (8.8%). Conclusions This single centre study demonstrates both 22G and 21G EBUS-TBNA samples are adequate for EGFR mutation analysis with no clear superiority in contrast to recent data suggesting disease phenotyping may be superior using a 21G needle when analysed by histopathology. We speculate that higher sample usability rates for mutation analysis may have been facilitated by the use of histological specimens however further larger studies are required to confirm this hypothesis. M12 EBUS-ARE TWO NEEDLES BETTER THAN ONE?WA Khan, S Bailey, M Najib; Manchester Royal Infirmary, Manchester, England 10. 1136/thoraxjnl-2013-204457.422 Introduction The introduction of endobronchial ultrasound has allowed visual sampling of nodes compared to the previous blind TBNA techniques. It was widely been used for patients with suspected lung. The purpose of our current study was to evaluate the usefulness of using a 2 needle technique compared to a single needle method in ebus sampling. The primary endpoint was to see the effect on the total number of biopsy passes, time between needle exchange and also total time taken to complete an ebus procedure. Method 20 patients with mediastinal and hilar lymphadenopathy or suspected lung cancer in our institution were included in this prospective study. EBUS-TBNA was performed in all cases. 10 procedures were used using a 2 needle technique and 10 procedures were performed with single needle. Two trained bronchoscopists with 2 trained nurses performing the needle exchange and on site cytopathologist were present at the bronchoscopy giving an instant preliminary diagnosis.Equal numbers of procedures were performed by each of the operators. Results EBUS-TBNA was successfully performed in all 20 patients recruited. In the single needle technique the average number biopsy passes performed was 3.8 per ebus with an average needle changeover delay of 2 minutes 21 seconds and an average ebus time of 27 minutes. The two needle technique showed a greater number biopsy passes of 4.4 per ebus with a significantly reduced changeover needle time delay of 18 seconds per changeover and a reduction in overall ebus time to 21 minutes per procedure. All the procedures were uneventful without complications. All sample were labe...

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