Vieira Pedro P M G, Braga Josefina A P, Regacini Rodrigo
Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil.
Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM UNIFESP), São Paulo, SP, Brazil.
Hematol Transfus Cell Ther. 2024 Nov;46 Suppl 5(Suppl 5):S239-S245. doi: 10.1016/j.htct.2024.07.003. Epub 2024 Sep 23.
This study aims to identify lung ultrasound (LUS) findings associated with acute chest syndrome (ACS) at the time of admission and 24-48 h later, to compare these to chest radiography (CXR) findings and to establish a score to predict the development of this pulmonary complication in sickle cell disease (SCD) children METHODS: A prospective observational study of SCD children presenting signs or symptoms of ACS evaluated by LUS and CXR at admission and 24-48 h later. A score was conceived to predict the evolution of ACS during hospitalization based on ultrasonographic findings.
Seventy-eight children were evaluated; 61 (78.2 %) developed ACS. A score greater than one at admission showed sensitivity, specificity, accuracy, and positive predictive value (PPV) of 75.4 %, 88.2 %, 78.2 %, and 95.8 %, respectively to predict ACS, while only 32 (52.5 %) CXR showed alterations. The development of ACS during hospitalization was unlikely for a score of zero and very likely for a score greater than one at admission. Regarding follow-up exams, a score greater than one showed sensitivity, specificity, accuracy, and PPV of 98.4 %, 76.5 %, 93.6 %, and 92.8 %, respectively to predict the development of ACS. ACS development was very unlikely for a score of zero and very likely for a score greater than zero in the follow-up.
LUS is an effective tool to assess risk for the development of ACS in SCD children with clinical suspicion.
本研究旨在确定入院时及之后24 - 48小时与急性胸部综合征（ACS）相关的肺部超声（LUS）表现，将这些表现与胸部X线摄影（CXR）结果进行比较，并建立一个评分系统来预测镰状细胞病（SCD）患儿发生这种肺部并发症的情况。方法：对出现ACS体征或症状的SCD患儿进行前瞻性观察研究，在入院时及24 - 48小时后通过LUS和CXR进行评估。根据超声检查结果构思了一个评分系统来预测住院期间ACS的进展。
评估了78名儿童；61名（78.2%）发生了ACS。入院时评分大于1对预测ACS的敏感性、特异性、准确性和阳性预测值（PPV）分别为75.4%、88.2%、78.2%和95.8%，而只有32例（52.5%）CXR显示有改变。入院时评分为零的患儿住院期间发生ACS的可能性不大，而评分大于1的患儿发生ACS的可能性很大。关于随访检查，评分大于1对预测ACS进展的敏感性、特异性、准确性和PPV分别为98.4%、76.5%、93.6%和92.8%。随访时评分为零的患儿发生ACS的可能性非常小，而评分大于零的患儿发生ACS的可能性很大。
对于临床怀疑的SCD患儿，LUS是评估发生ACS风险的有效工具。
