Pollack C V, Jorden R C, Kolb J C
Division of Emergency Medicine, University of Mississippi Medical Center, Jackson 39216-4505.
Ann Emerg Med. 1991 Nov;20(11):1210-4. doi: 10.1016/s0196-0644(05)81473-8.
To determine the usefulness of obtaining routine chest radiographs and urinalyses on adults presenting to the emergency department in acute sickle cell pain crisis. The hypothesis tested is that in some adult sickle cell patients, sickle cell pain crises are precipitated or accompanied by acute infection that may be clinically occult and that routine screening for pulmonary or urinary tract infection would identify some of these precipitating illnesses.
Prospective clinical study.
A university hospital ED.
All patients more than 14 years old with S-S, S-C, or S-beta-thalassemia sickle hemoglobinopathies who presented to the ED with acute nontraumatic painful complaints during a six-month period.
All patients underwent posteroanterior and lateral chest radiography, routine urinalysis, and CBC count with reticulocyte count. A standard questionnaire for localizing symptoms of systemic, pulmonary, and urinary tract infection was completed for each patient. Urine cultures were ordered on all patients with voiding symptoms, flank pain, and/or more than 5 WBCs or RBCs per high-power field on urinalysis. Physical examination for evidence of pulmonary and urinary tract infection was carefully performed and recorded for subsequent analysis.
Seventy-one patients with 134 ED presentations were studied over a six-month period. Eight diagnoses of acute pneumonia were made. Four of these patients complained of chest pain (50% vs 48% overall) and three had shortness of breath (38% vs 21%). None of these patients complained of fever or symptoms of upper respiratory illness. Ten diagnoses of urinary tract infection were made. Four of these patients complained of dysuria and frequency; three complained of flank pain. Eleven of the 18 infections (61.1%) did not have a typical history for or suggestive physical or laboratory findings of bacterial infection.
In sickle cell disease patients with pain crisis, routine chest radiography and urinalysis may be clinically useful and cost effective in the early diagnosis of crisis-related infection.
确定对因急性镰状细胞疼痛危象就诊于急诊科的成年人进行常规胸部X光检查和尿液分析的作用。所检验的假设是，在一些成年镰状细胞病患者中，镰状细胞疼痛危象是由急性感染引发或伴有急性感染，而这种感染在临床上可能隐匿，并且对肺部或泌尿系统感染进行常规筛查能够识别出一些引发疾病的病因。
前瞻性临床研究。
一家大学医院的急诊科。
所有年龄超过14岁、患有S-S、S-C或S-β地中海贫血镰状血红蛋白病且在六个月内因急性非创伤性疼痛主诉就诊于急诊科的患者。
所有患者均接受后前位和侧位胸部X光检查、常规尿液分析以及全血细胞计数和网织红细胞计数。为每位患者填写一份用于定位全身、肺部和泌尿系统感染症状的标准问卷。对所有有排尿症状、胁腹疼痛和/或尿液分析中每高倍视野白细胞或红细胞超过5个的患者进行尿培养。仔细进行并记录肺部和泌尿系统感染体征的体格检查，以供后续分析。
在六个月期间对71例患者进行了134次急诊科就诊研究。确诊8例急性肺炎。其中4例患者主诉胸痛（占50%，而总体为48%），3例有呼吸急促（占38%，而总体为21%）。这些患者均无发热或上呼吸道疾病症状。确诊10例泌尿系统感染。其中4例患者主诉排尿困难和尿频；3例主诉胁腹疼痛。18例感染中有11例（61.1%）没有细菌感染的典型病史或提示性的体格检查或实验室检查结果。
对于患有疼痛危象的镰状细胞病患者，常规胸部X光检查和尿液分析在早期诊断与危象相关的感染方面可能具有临床实用性且具有成本效益。
