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

Am J Emerg Med. 2018 Oct;36(10):1855-1861. doi: 10.1016/j.ajem.2018.07.006. Epub 2018 Jul 3.

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: Acute chest syndrome; Lung consolidation; Lung ultrasound; Pleural effusion; Sickle cell.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Chest Syndrome / diagnostic imaging*
  • Acute Chest Syndrome / etiology
  • Adult
  • Anemia, Sickle Cell / complications
  • Anemia, Sickle Cell / diagnostic imaging*
  • Anemia, Sickle Cell / physiopathology
  • Chest Pain / diagnostic imaging*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Ultrasonography*