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Am J Emerg Med. 2018 Oct;36(10):1855-1861. doi: 10.1016/j.ajem.2018.07.006. Epub 2018 Jul 3.

Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients.

Author information

1
Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, 808 South Wood Street, MC 724, Chicago, IL 60612, United States of America; Department of Emergency Medicine, University of Illinois Medical Center, 1740 West Taylor Street, Chicago, IL 60612, United States of America.
2
University of Illinois Honors College, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, United States of America.
3
Center for Clinical and Translational Science, University of Illinois at Chicago, 914 South Wood Street, MCA, Room 321, Chicago, IL 60612, United States of America. Electronic address: yfchen2@uic.edu.
4
Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, College of Medicine, 820 S. Wood Street, MC 712, Chicago, IL 60612, United States of America; Division of Hematology and Oncology, Department of Medicine, Jesse Brown VA Medical Center, Medical Service, MP 111, Chicago, IL 60612, United States of America. Electronic address: remoloki@uic.edu.
5
Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, 808 South Wood Street, MC 724, Chicago, IL 60612, United States of America; Department of Emergency Medicine, University of Illinois Medical Center, 1740 West Taylor Street, Chicago, IL 60612, United States of America. Electronic address: ppraja2@uic.edu.

Abstract

BACKGROUND:

Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.

OBJECTIVE:

Investigate the use of bedside lung ultrasound (BLU) in identification of early pulmonary findings associated with ACS in SCD patients.

METHODS:

Prospective, observational study of a convenience sample of SCD patients presenting to the Emergency Department (ED) for a pain crisis. BLU interpretations were made by an emergency physician blinded to the diagnosis of ACS, and were validated by a second reviewer. The electronic medical record was reviewed at discharge and at 30 days.

RESULTS:

Twenty SCD patients were enrolled. Median age was 31 years, median hemoglobin was 7.7 g/dL. Six patients developed ACS. Five patients in the ACS group had lung consolidations on BLU (83%) compared to 3 patients in the non-ACS group (21%), p = 0.0181, (OR = 12.05, 95% CI 1.24 to 116.73). The ACS group was also more likely to have a pleural effusion and B-lines on BLU than the non-ACS group, p = 0.0175; 0.1657, respectively. In the ACS group, peripheral and frank consolidations on BLU was 83% and 50% sensitive, 79% and 100% specific for ACS, respectively; whereas an infiltrate on initial chest X-ray (CXR) was only 17% sensitive. BLU identified lung abnormalities sooner than CXR (median 3.6 vs. 31.8 h).

CONCLUSIONS:

Pulmonary abnormalities on BLU of an adult SCD patient presenting to the ED for a painful crisis appear before CXR, and highly suggest ACS. BLU is a promising predictive tool for ACS.

KEYWORDS:

Acute chest syndrome; Lung consolidation; Lung ultrasound; Pleural effusion; Sickle cell

PMID:
30017686
DOI:
10.1016/j.ajem.2018.07.006

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