Preflight Medical Screenings of Patients: Results

Preflight Medical Screenings of Patients: ResultsThe medical advisory service evaluated 1,115 patients during the 12-month period, with 93 ± 13.3 (SD) screenings per month (Fig 1). These patients represented 0.003 percent of the 42,770,468 passengers flown on the carriers domestic flights during 1991 (S. Whitehead, oral communication, August, 1992). The advisory service also screened 784 patients referred from Delta in 1989 and 968 patients in 1990. Thus, the annual number of screened patients constituted a very low proportion of total passengers, but the number progressively increased each year.
The 1,115 patients were operationally classified into three groups (Fig 2). The oxygen group consisted of 892 (80 percent) patients requesting or requiring inflight oxygen therapy. The other pulmonary group consisted of 51 (4.6 percent) pulmonary patients not requiring oxygen therapy but who had a major respiratory diagnosis and who may have requested special services, eg, equipment for suctioning or monitoring (eg, apnea monitor). The nonpulmonary group consisted of 172 (15.4 percent) patients with nonpulmonary medical conditions or needs. The average age of patients in the three groups was 59.2 (median, 68; range—0.01 to 99), 33.6 (median, 28; range—0.04 to 89), and 42.1 (median, 39; range—0.8 to 95) years, respectively. The screened passengers had fairly even age distribution (Fig 3), except the oxygen group had a bimodal age pattern with a large number of elderly patients. Approximately 78 percent (656) of patients in the oxygen group were 50 years of age or older and 67 percent (561) were 60 years of age or older.
Other demographic and medical characteristics of each group are summarized in Table 1. Most patients were ambulatory, although one third of all patients recently had been hospitalized, including 28 percent who were hospitalized in an acute care facility during the screening. A sizeable number of patients (148 or 13.2 percent) reported a history of allergies to drugs or other agents. Patients in the oxygen group reported various cardiopulmonary and other medical conditions; of these, COPD (44.3 percent) and cardiac disorders (34.1 percent) were the most frequent. Eighty-six (9.6 percent) patients in the oxygen group had concurrent COPD and cardiac disorders. Obstructive airways disease and cardiac disorders were most frequent in the other pulmonary group, whereas neuropsychiatric and orthopedic conditions were predominant in the nonpulmonary group. Overall, COPD, followed by cardiac, other respiratory, neuropsychiatric, and orthopedic conditions were most frequently documented by preflight screening. Patients also traveled with recently treated tuberculosis (two patients), apnea syndromes (three adults and nine infants), recent pacemaker insertion (ten subjects), and AIDS (nine patients). Forty-five patients with congenital heart disease were less than 10 years of age, and most (43 patients) required in-flight oxygen therapy. Ten passengers were to be evaluated for heart, lung, or liver transplantation at their destinations.

Figure-1

Figure 1. Monthly distribution of preflight medical screenings in 1991.

Figure-2

Figure 2. Distribution of 1,115 preflight medical screenings according to category. Parentheses enclose number of screenings per category.

Figure-3

Figure 3. Frequency distribution of 1,115 evaluated patients according to decade of age and category.

Table 1—Demographic and Medical Characteristics of Patients Undergoing Preflight Medical Screening

Characteristics Oxygen Croup (n = 892), No. (%) Other Pulmonary (n — 51), No. (%) Nonpulmonary (n —172), No. (%) Total (n= 1,115), No. (%)
Males 103 (44.2) 51 (60.8) 96 (55.8) 540 (48.4)
Females 130 (55.8) 20 (39.2) 76 (44.2) 575 (51.6)
Ambulatory 723 (81.1) 31 (60.8) 80 (46.5) 834 (74.8)
Hospital discharge (<2 wk)* 302 (33.8) 18 (35.3) 66 (38.4) 386 (34.6)
In hospital during inquiry 241 (27.0) 14 (27.4) 58 (33.7) 313 (28.1)
History of drug allergy 127 (14.2) 2 (3.9) 19 (11.0) 148 (13.2)
Major diagnostic categoriest
COPD 395 (44.3) 8 (15.6) 2 (1.2) 405 (36.3)
Asthma 41 (4.6) 14 (27.5) 1 (0.6) 56 (5.0)
Interstitial lung disease 51 (5.7) 1 (1.9) 0 52 (4.6)
Cystic fibrosis 11 (1.2) 1 (1.9) 0 12 (1.1)
Neuromuscular disorder 14 (1.6) 2 (3.9) 10 (5.8) 36 (3.2)
Pneumonia (<1 month)* 62 (6.9) 5 (9.8) 1 (0.6) 68 (6.1)
Pulmonary embolism 14 (1.6) 1 (1.9) 0 15 (1.3)
Pulmonary hypertension 19 (2.1) 1 (1.9) 0 20 (1.8)
Lung cancer 60 (6.7) 0 0 60 (5.4)
Other malignancy 42 (4.7) 2 (1.9) 16 (9.3) 60 (5.4)
Bronchopulmonary dysplasia 20 (2.2) 0 0 20 (1.8)
Cardiac disorder 304 (34.1) 10 (19.6) 17 (9.8) 331 (29.7)
Neuropsychiatric disorder 74 (8.3) 7 (13.7) 96 (55.8) 177 (15.8)
Hematologic disorder 8 (0.9) 1 (1.9) 1 (0.6) 10 (0.8)
Orthopedic condition 7 (0.8) 0 37 (21.5) 44 (3.9)
Diabetes mellitus, ID$ 18 (2.0) 1 (1.9) 4 (2.3) 23 (2.0)
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