Risk of Early Deterioration in Emergency Department Patients Presenting with Non-Massive Hemoptysis: A Prospective Cohort Study

Background: Non-massive hemoptysis is generally considered low-risk and manageable with conservative treatment. However, some patients progress to massive hemoptysis during follow-up. Identifying high-risk patients early in the emergency department matters for calibrating monitoring intensity, guiding timely intervention, and allocating acute care resources. This study aimed to identify clinical, laboratory, and radiological predictors of progression to massive hemoptysis within the first 72 h in emergency department patients presenting with non-massive hemoptysis who were managed conservatively. Methods: This prospective cohort study enrolled patients at a tertiary university hospital emergency department between November 2023 and June 2025. Adult patients presenting with non-massive hemoptysis were enrolled consecutively. The primary outcome was development of massive hemoptysis within 72 h of admission. Patients were divided into two groups: those who developed massive hemoptysis within 72 h and those who did not. Demographic, bleeding, laboratory, imaging, and bronchoscopy data were recorded for all patients. Multivariate logistic regression was used to identify independent predictors. Results: Of 199 patients, 10.6% developed massive hemoptysis within the first 72 h. On multivariate analysis, bright red hemoptysis (3.17-fold increase in risk), a cavity or mass on thoracic CT (7.13-fold increase in risk), and bleeding volume ≥20 mL in a single episode (3.3-fold increase in risk) were independent predictors of massive hemoptysis. Conclusions: A meaningful proportion of patients presenting with non-massive hemoptysis go on to develop massive hemoptysis in the early period. Simple clinical and radiological parameters available at admission can support early risk stratification and inform decisions regarding monitoring intensity and early inpatient management during the critical first 72 h after emergency department admission. These findings may assist early risk stratification but should complement, rather than replace, clinical judgement.