Eisenbrown Katherine, Nimmer Mark, Ellison Angela M, Simpson Pippa, Brousseau David C
Medical College of Wisconsin, Milwaukee, WI.
Pediatric Emergency Medicine and the Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI.
Acad Emerg Med. 2016 Nov;23(11):1248-1256. doi: 10.1111/acem.13048. Epub 2016 Nov 1.
Controversy exists regarding which febrile children with sickle cell disease (SCD) should receive a chest x-ray (CXR). Our goal is to provide data informing the decision of which febrile children with SCD presenting to the emergency department (ED) require a CXR to evaluate for acute chest syndrome (ACS).
Retrospective chart review of children ages 3 months to 21 years with SCD presenting to the ED at one of two academic children's hospitals with fever ≥38.5°C between January 1, 2010, and December 31, 2012. Demographic characteristics, respiratory symptoms, and laboratory results were abstracted. The primary outcome was the presence of ACS. Binary recursive partitioning was performed to determine predictive factors for a diagnosis of ACS.
A total of 185 (10%) of 1,837 febrile ED visits met ACS criteria. The current National Heart, Lung, and Blood Institute (NHLBI) consensus criteria for obtaining a CXR (shortness of breath, tachypnea, cough, or rales) identified 158 (85%) of ACS cases, while avoiding 825 CXRs. Obtaining a CXR in children with NHLBI criteria or chest pain and in children without those symptoms but with a white blood cell (WBC) count ≥18.75 × 10 /L or a history of ACS identified 181 (98%), while avoiding 430 CXRs.
Children with SCD presenting to the ED with fever and shortness of breath, tachypnea, cough, rales, or chest pain should receive a CXR due to high ACS rates. A higher WBC count or history of ACS in a child without one of those symptoms may suggest the need for a CXR. Prospective validation of these criteria is needed.
对于哪些患有镰状细胞病（SCD）的发热儿童应接受胸部X光检查（CXR）存在争议。我们的目标是提供数据，以指导决定哪些到急诊科（ED）就诊的患有SCD的发热儿童需要进行CXR检查以评估急性胸综合征（ACS）。
对2010年1月1日至2012年12月31日期间在两家学术儿童医院之一因发热≥38.5°C到ED就诊的3个月至21岁的SCD儿童进行回顾性病历审查。提取人口统计学特征、呼吸道症状和实验室检查结果。主要结局是是否存在ACS。进行二元递归划分以确定ACS诊断的预测因素。
在1837次发热的ED就诊中，共有185次（10%）符合ACS标准。当前美国国立心肺血液研究所（NHLBI）获取CXR的共识标准（呼吸急促、呼吸过速、咳嗽或啰音）识别出158例（85%）ACS病例，同时避免了825次CXR检查。对符合NHLBI标准或有胸痛的儿童以及没有这些症状但白细胞（WBC）计数≥18.75×10⁹/L或有ACS病史的儿童进行CXR检查，识别出181例（98%）ACS病例，同时避免了430次CXR检查。
因ACS发生率高，到ED就诊且伴有发热和呼吸急促、呼吸过速、咳嗽、啰音或胸痛的SCD儿童应接受CXR检查。没有上述症状之一但白细胞计数较高或有ACS病史的儿童可能提示需要进行CXR检查。需要对这些标准进行前瞻性验证。
