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

  • Joseph S. Colla
    Affiliations
    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
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  • Pavitra Kotini-Shah
    Affiliations
    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
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  • Savannah Soppet
    Affiliations
    University of Illinois Honors College, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, United States of America
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  • Yi-Fan Chen
    Affiliations
    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
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  • Robert Molokie
    Affiliations
    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
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  • Puja Prajapati
    Correspondence
    Corresponding author.
    Affiliations
    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
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  • Heather M. Prendergast
    Affiliations
    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
    Search for articles by this author

      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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