Pleural Effusion Clinical Trial
Official title:
Clinical Identification of Malignant Pleural Effusions in the Emergency Department
Pleural effusions (PE) are common conditions that signal either infection or cancer. The investigators aim to develop, validate, and prospectively assess the MAPED score, a clinical score that predicts malignancy at admission. This tool will assist clinicians all over the world to rapidly assess the probability of an effusion being malignant within 4 hours of admission.
Background: Pleural effusions (PE) are common conditions that signal either
pleural-disseminated infection or cancer. While these diagnoses bear tremendous importance
for patients, they require invasive procurement of pleural tissues and/or cells and time.
Simple and rapid diagnostic markers of pleural malignancy at admission that streamline
diagnostic and treatment efforts remain unidentified.
Objective: To develop, validate, and prospectively assess markers of malignancy of PE at
admission.
Methods: A prospective cohort of patients with PE from different etiologies will be recruited
stating on 11.21.2013 and prospectively ending on 11.21.2023. Data will be collected within 4
hours of admission including history, chest X-ray, and blood and pleural fluid (PF) cell
counts and basic biochemistry. Pleural fluid and serum will be biobanked for future analyses.
Patients will sign informed consent forms. Diagnosis will be confirmed using standard
microbiology, cytology, histology, and imaging techniques. Patients undiagnosed within a
month will be excluded. Variables will be entered into binary regression and
receiver-operator analyses using malignancy as the target to develop the MAPED score, a
clinical score that predicts malignancy at admission. MAPED will be retrospectively validated
in separate published cohorts from the first therapeutic interventions in malignant effusion
(TIME) 1-3 trials from Oxford UK. Data will be censored and analyzed three times, at 40-month
intervals since study initiation.
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