Khan Narmeen I, Coleman Keli D, Nimmer Mark, Brazauskas Ruta, Brousseau David C
Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, United States.
Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, United States.
Am J Emerg Med. 2025 Mar;89:75-77. doi: 10.1016/j.ajem.2024.12.019. Epub 2024 Dec 13.
The National Heart, Lung, and Blood Institute (NHLBI) defines acute chest syndrome (ACS) as a new infiltrate on chest x-ray (CXR) and at least 1 of the following: fever (≥38.5C), hypoxia, or respiratory symptoms. NHLBI expert consensus recommends a CXR in patients with sickle cell disease (SCD) who have fever and respiratory symptoms. Past work has shown that physicians fail to recognize ACS in children with SCD who present with fever, leading to varied CXR obtainment criteria.
To determine the prevalence of ACS in patients with SCD presenting to our ED with fever with or without respiratory symptoms.
A retrospective analysis of ED visits by patients with SCD (ages 0 to 20 years) who presented with fever (>/= 38.5 C) within the past 24 h between January 2019 to December 2022 was done. The presence or absence of NHLBI-defined respiratory symptoms and CXR results were extracted. The prevalence of ACS, demonstrated on CXR, for febrile children with and without respiratory symptoms was estimated.
There were 137 children (288 unique ED visits) with fever. We found 0 % of visits with fever and no respiratory symptoms had ACS whereas 22.6 % with at least 1 respiratory symptom (p < 0.001).
Our findings provide strong evidence that a CXR is not necessary in a child with SCD presenting to the ED with fever and no NHLBI-defined respiratory symptoms. This evidence could improve quality of care and decrease unnecessary CXR use in the SCD population.
美国国立心肺血液研究所（NHLBI）将急性胸综合征（ACS）定义为胸部X光（CXR）出现新的浸润影，且至少伴有以下一项：发热（≥38.5℃）、低氧血症或呼吸道症状。NHLBI专家共识建议，对患有镰状细胞病（SCD）且有发热和呼吸道症状的患者进行胸部X光检查。过去的研究表明，医生未能识别出患有SCD且出现发热症状的儿童中的急性胸综合征，导致胸部X光检查的获取标准不一。
确定因发热伴或不伴呼吸道症状到我院急诊科就诊的SCD患者中急性胸综合征的患病率。
对2019年1月至2022年12月期间，在过去24小时内出现发热（≥38.5℃）的0至20岁SCD患者的急诊就诊情况进行回顾性分析。提取是否存在NHLBI定义的呼吸道症状及胸部X光检查结果。估算有发热症状且有或无呼吸道症状的儿童中，胸部X光显示的急性胸综合征患病率。
共有137名发热儿童（288次独立急诊就诊）。我们发现，发热且无呼吸道症状的就诊患者中，急性胸综合征的患病率为0%，而至少有1种呼吸道症状的患者中这一比例为22.6%（p<0.001）。
我们的研究结果提供了有力证据，表明对于因发热且无NHLBI定义的呼吸道症状到急诊科就诊的SCD儿童，无需进行胸部X光检查。这一证据可改善医疗质量，并减少SCD人群中不必要的胸部X光检查使用。
