title: The use of incentive spirometry in pediatric patients with sickle cell disease to reduce the incidence of acute chest syndrome.
abstract: BACKGROUND
  To determine if incentive spirometry (IS) in pediatric patients admitted with sickle cell disease for nonrespiratory complaints will decrease acute chest syndrome (ACS).
  
  
  METHODS
  This was an Institutional Review Board-approved before-after 2-year retrospective cohort study evaluating an evidence-based guideline (EBG) initiating mandatory IS in admitted pediatric sickle cell patients from a tertiary children's emergency center. Student t testing and χ² analysis were performed.
  
  
  RESULTS
  There were 1551 patient visits. About 258 visits were enrolled in the pre-EBG year, and 230 in the EBG year. Between year characteristics were similar. The EBG year reported higher use of hydroxyurea (P<0.01), analgesics (P=0.02), and chest pain (P=0.03). Sixty-seven patients (25.9%) in the pre-EBG year received transfusions versus 51 (22.5%) in the EBG year (NS). Twenty-five (9.6%) of the pre-EBG patients received blood for ACS versus 14 (6.1%) in the EBG group (absolute risk reduction: 3.5%, 95% confidence interval: -1-8.4%). Subgroup analysis revealed that patients who presented with back pain experienced a significant decrease in the development of ACS in the EBG year (P=0.04, absolute risk reduction: 14%, 95% confidence interval: 1-28%, number needed to treat: 8).
  
  
  CONCLUSIONS
  Mandatory IS for sickle cell disease patients admitted without respiratory complaints reduces transfusions and ACS, particularly for those presenting with back pain.
authors.affiliation: Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Fahd A
authors.initials: FA
authors.lastname: Ahmad
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Allen
mesh_terms: D056586:Acute Chest Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013147:Spirometry