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
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Article Info
Publication History
Published online: July 02, 2018
Accepted:
July 2,
2018
Received in revised form:
July 1,
2018
Received:
February 9,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
