Flexible bronchoscopy indications and outcomes between indigenous and non-indigenous patients in the Northern Territory of Australia

Mohammad M Seyedshahabedin; Timothy P Howarth; Lin Mo; Edwina Biancardi; Subash S Heraganahally

doi:10.1111/imj.15865

Flexible bronchoscopy indications and outcomes between indigenous and non-indigenous patients in the Northern Territory of Australia

Intern Med J. 2023 Sep;53(9):1634-1641. doi: 10.1111/imj.15865. Epub 2022 Sep 16.

Authors

Mohammad M Seyedshahabedin¹, Timothy P Howarth^{2

3}, Lin Mo¹, Edwina Biancardi¹, Subash S Heraganahally^{1

3

4}

Affiliations

¹ Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
² College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.
³ Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.
⁴ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

PMID: 35789046
DOI: 10.1111/imj.15865

Abstract

Background: There is sparse evidence in the literature in relation to indications and outcomes among adult indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between indigenous and non-indigenous patients were assessed.

Aim: To assess the similarities and differences of FB indications and outcomes between indigenous and non-indigenous patients.

Methods: Self-reported indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between indigenous and non-indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes.

Results: Of the 403 patients, 111 (28%) were indigenous, and indigenous patients were younger (mean difference 11 years) and had a higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, although indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, indigenous patients had a higher presence of Streptococcus pneumoniae (30% vs 9%), while non-indigenous patients had a higher presence of Pseudomonas aeruginosa (43% vs 11%) and mycobacteria (15% vs 4%). There was no significant difference between indigenous and non-indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%).

Conclusions: This study has demonstrated that adult indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and demonstrate differing microbiology with no significant difference in the diagnostic outcomes for lung malignancy. Ethnic status or remoteness should not preclude indigenous patients to undergo a FB if clinically indicated.

Keywords: aboriginal; first nations; infection; lung cancer; malignancy.

MeSH terms

Adult
Bronchoscopy* / methods
Humans
Lung Neoplasms* / diagnosis
Northern Territory / epidemiology
Retrospective Studies
Tomography, X-Ray Computed